2019年8月18日星期日

《朱良春用藥經驗集》:五靈脂降濁氣而和陰陽

五靈脂乃寒號蟲之所遺,味甘氣溫,氣味俱厚,能入足厥陰肝經及手少陰心經。其與蒲黃相伍(失笑散),治惡露不行,脘脅刺痛,死血腹痛,故一般均認為本品是活血散血之要藥。

「五靈脂能入血分以行營氣,能降濁氣而和陰陽。」
  • 本品配合乳香,沒藥組成「鐵彈丸」,可「治一切癱瘓風」,取其運行血中之氣,通經活絡之功。
  • 本品配合玄胡,莪朮,高良姜,當歸,「治急心痛,胃痛」,取其行營氣,消瘀止痛之功。
  • 本品降濁氣的作用可參考「鼓脹」的治療,「來复丹」引用本品。
  • 靈丑散(五靈脂,黑丑等份為末,每服3-6克),對痢疾,泄瀉初起,胃腸積滯未消者,療效甚佳,此為善用五靈脂者。「凡痰瘀交阻,宿食不消,濁氣壅塞,而致腹痛撐脹」,本品可使濁氣下降,陰陽調和,消脹定痛。

五靈脂亦可治療肺脹(肺氣腫,COPD)。本病多繼發於慢性支氣管炎,哮喘等疾病,由於肺臟膨脹,故名「肺脹」。《普濟方》皺肺丸,治久咳,喘咳,痰紅。《普濟方》:「治咳嗽肺脹,動則短氣」。皺肺丸由五靈脂60克,柏子仁15克,胡桃肉(去殼)8枚組成,共研成膏,滴水為丸,如小豆大,甘草湯過口,每服15粒,1日2次。本方有袪瘀化痰,斂肺納腎之功,對肺氣腫之輕者有較好的療效。



2019年8月17日星期六

食物的營養成分及保健功效 - 鴨肉

鴨肉

適宜:營養不良,病後體虛,低熱,水腫者

不宜:寒性痛經,胃痛,腹瀉患者。

營養成分:含蛋白質,脂肪,碳水化合物,維他命A,維他命B2,維他命E,鈣,磷,鉀,鈉,鎂,鐵,鋅,銅等。

保健功效:味甘鹹,性平,可滋陰養胃,利水消腫,可治血虛頭痛,陰虛失眠,肺熱咳嗽,腎炎水腫,小便不利,潮熱骨蒸等症。



2019年8月16日星期五

《朱良春用藥經驗集》:蒼耳子有通督升陽之功

蒼耳子味甘苦,性溫,善發汗,袪風濕,通鼻竅,以擅治鼻淵,風疹,痹痛等。蒼耳子的應用主要有以下三個要點:

  • 通督升陽,以解項背攣急
此症多由先天不足,風寒濕邪襲於背俞,筋脈痹阻而致。若纏綿不解,病邪深入經骨,每膠著難愈,常以蒼耳子與葛根相伍,邪在筋脈則更配當歸,威靈仙之類;邪已深入骨則佐以熟地,鹿銜草,仙靈脾,烏梢蛇,露蜂房之類。蒼耳子能「走督脈」,項背攣急乃督脈主病,用之既有引經作用,又有袪邪作用。《本經》:「主惡肉死肌」,蓋風濕去而氣血流暢,瘀去新生。

  • 袪風解毒
配一枝黃花治流感發熱,外邪襲表,肺衛首當其衝,則會出現鼻塞,咳嗽,寒熱等症狀。蒼耳子能抗病毒,一枝黃花涼而能散,能疏風清熱解毒,凡風熱流感,用此二味藥,隨症佐藥,以驅風解毒,透竅發汗,患者服後,往往頭痛,咽癢,鼻塞,咳嗽緩解,身熱頓挫。
 
  • 以一味蒼耳子治療濕性濡泄
用風藥治瀉,蓋風能勝濕,清氣上行,濁邪下降,脾胃功能恢復,泄瀉自愈。夏秋之季,濕邪浸淫,濡泄多見,一味蒼耳子即可勝任,若加入辨証論治方藥中,療效更佳。 


2019年8月15日星期四

食物的營養成分及保健功效 - 鵝肉

鵝肉

適宜:身體虛弱,氣血不足,營養不良者。

不宜:溫熱內積者,頑固性皮膚疾患者,腫瘤,高血壓,高血脂症,動脈硬化患者等。

營養成分:含蛋白質,脂肪,維他命A,維他命B,鈣,磷等。

保健功效:味甘性平,入脾,肺,肝經,可益氣補虛和胃,適用於虛勞消瘦,消渴等。


2019年8月14日星期三

《朱良春用藥經驗集》:疏肝妙品生麥芽

麥芽是大麥發芽而成,為臨床常用的消食中藥,一般用於傷於米麵飲食,症見胃脘脹滿,納呆,腹瀉患者。大麥芽與神曲,山楂等分,炒微焦,研細末,拌勻,為「焦三仙」,再加焦檳榔,則為「焦四仙」,可開胃進食,和中止瀉。小兒傷乳,吐奶,腹瀉,單用大麥芽亦效。此外,炒麥芽大劑量120克煎湯用於回乳,1日1劑,每次飲1大碗,不出二三日即收效。

大麥芽又為疏肝妙藥,「雖為脾胃之藥,而實善舒肝氣。」七情之病,多從肝起,肝主一身之里也。肝氣易鬱,鬱則了疏泄失職。疏與泄,均有通達之意,且肝主條達,故肝鬱之用藥,疏泄以復其條達之常。常用藥如柴胡,香附,川芎,薄荷等,一般多用柴胡疏肝散,越鞠丸,逍遙散去白朮及甘草之壅,加鬱金。

不過疏肝之藥皆辛溫香燥升散,故只可暫用,不可久用,宜用小量,不宜大量。尤其是肝病日久,肝陰不足,又兼肝鬱氣滯者,不疏肝則無以行滯,疏肝則香燥之藥難免傷陰。見一貫煎一方,於甘潤之中,加川楝子一味,川楝子雖能瀉肝行氣,但始終性味苦寒容易傷中。唯大麥芽疏肝而無溫燥劫陰之弊,且久用及重用也不成問題,而且味甘入脾,其性微溫,不僅不敗胃,而且能助胃進食,「見肝之病,知肝傳脾,當先實脾」。

慢性肝炎,肝陰不足,症見爪甲少華,口燥咽乾,潮熱倦怠,胃納不佳,食後脹悶不適,大便乾結,兩脅脹痛,常用一貫煎加減,多以生麥芽易川楝子,藥如枸杞子,北沙參,麥冬,制首烏,宣木瓜,蒲公英,生麥芽,生地,制黃精,雞血藤等。如肝火熾盛之目赤,煩躁不安,脅肋脹痛,當用川楝子以瀉肝止痛者,亦必加大量生麥芽以為輔佐。生麥芽用量以每劑30克為宜。


2019年8月13日星期二

食物的營養成分及保健功效 - 雞蛋

雞蛋

適宜:虛勞消瘦,脾虛食少,產後缺乳,病後虛弱,營養不良性水腫患者。

不宜:高熱,腹瀉,肝炎,腎炎,膽囊炎,冠心病患者。

營養成分:含豐富的蛋白質,氨基酸,脂肪,碳水化合物,維他命A,維他命B1,維他命B2,維他命B6,維他命B12,維他命D,維他命E,葉酸,鈣,鐵,磷,鎂,鋅,銅,碘等。

保健功效:味甘性平,可補氣養血,滋陰熄風,養心安神。雞蛋熟食,可補氣血,安五臟。



2019年8月12日星期一

《朱良春用藥經驗集》:十大功勞善清虛熱,補而不膩

十大功勞入藥統稱功勞葉,性味屬苦寒,有清熱,解毒,健胃(小劑量)作用,常用於黃疸,肝炎,膽囊炎,瘡癰,目赤,風火牙痛,急性腸炎,痢疾等疾病。

功勞葉多用於肺腎陰虛之骨蒸勞熱(包括結核病潮熱),功勞葉配地骨皮,女貞子,北沙參,天冬,麥冬,黃精,百合,川貝,桃仁等,不但對肺結核潮熱有顯著退熱之效,且可止咳止血,促進病灶鈣化,增強患者體質。

對諸多慢性病過程中出現的低熱,煩熱,陰虛火旺者,常與生地,玄參,麥冬,地骨皮,白芍,女貞子,墨旱蓮等滋陰之品配合,收效亦佳。此外,功勞葉長服久服,亦無傷胃之弊,不少患者用後反能增進食欲。一般用量以10-15克為宜。

功勞葉和黃連,黃柏,黃芩不同之點,在於其兼有一定滋養作用;
功勞葉和天冬,麥冬,生地等滋陰藥不同之點,在於其補乃是清補而非膩補,故絕不會滋膩助邪。在這點上,其作用又近於女貞子,但功勞葉還有清熱退蒸之功。 


2019年8月11日星期日

食物的營養成分及保健功效 - 蠔 (牡蠣)

蠔 (牡蠣)

適宜:婦女更年期綜合症患者。

不宜:急慢性皮膚病患者,脾胃虛寒,慢性腹瀉,大便稀爛者。

營養成分:含蛋白質,氨基酸,維他命A,維他命B雜,維他命E,鋅,銅,鈣等。

保健功效:味甘鹹,性平,入肝,心,腎經,可滋陰養血,補五臟,適用於虛損勞疾,失眠心悸,陰虛血虧等。



2019年8月10日星期六

《朱良春用藥經驗集》:天花粉的五用

天花粉,即為瓜蔞之根(瓜蔞根),其性寒,味甘苦,為常用清熱瀉火的中藥。《本草綱目》:「味甘,微苦酸」,「酸能生津,故能止渴潤枯,微苦降火,甘不傷胃」。因其性寒,對脾胃虛弱者需慎用。

天花粉以生津止渴為長,熱病傷津,責之肺胃,本品入肺胃經,清熱生津。雜病中也有以口渴為主訴者,或嗜食肥甘厚味,煙酒過多,肝鬱化火,傷及肺胃之津者,常以天花粉配玄參、麥冬、生甘草,或作湯劑,或作藥茶代飲料,取效甚捷。如前人所說:「瓜蔞根純陰,解煩渴,行津液,心中枯涸者,非此不能除。」 

天花粉還能化熱痰,可「降膈上熱痰」,燥熱傷肺,痰黏稠,不易咯出,口渴面赤,可用天花粉配瓜蔞皮,杏仁,川貝,桑白皮,生甘草,魚腥草(需用20-30克),枇杷葉。

天花粉又為清暑解毒妙品,用於痱子(夏季皮炎)、瘡癤(暑癤)、濕疹,兼見口渴,心煩,尿短赤者,內服常與金銀花、連翹、淡竹葉、滑石、生甘草、蒲公英、綠豆衣配伍。外用可單用天花粉或配半量滑石粉,少許冰片,研極細末作皮膚撒布劑。

糖尿病亦常重用天花粉(30克),可以緩解三多(飲水多,飲食多,小便多)的症狀,可參考玉液湯(黃芪,山藥,天花粉,知母,葛根,五味子,雞內金)。

天花粉治瘡癰亦有效,「消腫毒,乳癰,發背,痔漏瘡癤,排膿生肌長肉,消仆損瘀血」,可參考仙方活命飲(金銀花,防風,白芷,當歸,天花粉,陳皮,赤芍,甘草,浙貝母,山甲珠,皂角刺,乳香,沒藥)。此方不限於皮膚瘡瘍,對內癰(如腸癰即急性闌尾炎)及深部膿腫也極有效。「癰腫之處,必有伏陽」,天花粉既有清熱瀉火之用,又有消瘀排膿之長。

現代藥理研究証實:天花粉蛋白質可致流產及抗早孕。婦科臨床也有用天花粉作人工流產:從天花粉中提取的一種有較強抗原性的植物蛋白制成的注射劑,用後引起胎盤滋養葉細胞急性凝固性壞死,而導致胎盤功能喪失,並在羊膜,絨毛膜板及胎膜形成化學性炎症,刺激子宮壁產生激烈宮縮,促死胚胎排出。但內服天花粉尚未發現這樣的作用,因此值得進一步研究。


2019年8月9日星期五

食物的營養成分及保健功效 - 三文魚

三文魚

適宜:心血管疾病,貧血患者。

不宜:孕婦,過敏體質者,痛風患者,高血壓患者。

營養成分:含豐富的不飽和脂肪酸。

保健功效:味甘性平,入脾、胃經,有補虛勞,健脾胃,暖胃和中的功效,適用於消瘦,水腫,消化不良等症。



2019年8月8日星期四

《朱良春用藥經驗集》:澤瀉利大小便,輕身減肥

澤瀉甘淡性寒,其功長於利水,且經現代藥理研究証實。但其用量若大於30克(湯劑),亦可通大便。

重用澤瀉可治療單純性肥胖,高膽固醇血症,脂肪肝,糖尿病及原發性高血壓症。

《神農本草經》:「久服耳目聰明,不飢,延年,輕身,面生光,能行水上。」朱老認為,「能行水上」實為輕身之意,可解作減體重的意思。

現代醫學研究發現,澤瀉有:
  • 降血糖作用
  • 減輕血膽固醇在血液內滯留
  • 持續降低血壓的作用
  • 抗脂肪肝作用
  • 降低血中膽固醇含量
  • 緩和粥樣硬化作用

朱老「降脂減肥湯」: 
制蒼朮,黃芪,澤瀉,淫羊藿,生苡仁,冬瓜皮,冬瓜仁,荷葉,決明子,丹參,法夏,山楂,枳殼。水煎服,或改作丸劑亦可。
患者若能堅持服藥,適當節食配合運動,減肥效果不錯。


2019年8月7日星期三

食物的營養成分及保健功效 - 鰻魚

鰻魚

適宜:老年人及久病體弱者,貧血者。

不宜:患有慢性疾病及對海鮮過敏者,病後脾腎虛弱,痰多泄瀉者。

營養成分:含蛋白質,脂肪,碳水化合物,維他命A,維他命B1,維他命B2等。

保健功效:味甘性平,入肺,脾,腎經,可健脾,補肺,益腎,固沖等,適用於五臟虛損,消化不良,小兒疳積,痔瘡及脫肛等。


2019年8月6日星期二

《朱良春用藥經驗集》:路路通行氣活血,利水消腫

路路通才薄不堪重用,多作輔佐性質,亦自有其功效。

路路通之作用在於通利,故無論滯氣,瘀血,停痰,積水,均可用之以作開路:
  • 氣滯胃痛,証見脘腹脹悶,走窜仍痛,噯氣,大便不爽,常用辛香行氣中藥如香附,木香,枳殼,青皮,陳皮,川楝子等,加入路路通,則其效更捷 
  • 滯氣窜入經絡,周身痹痛,或在四肢,或在腰背,走窜不定,其人鬱鬱不樂,噯氣頻頻,常用羌活,獨活,桑枝,秦艽,防風,細辛,川芎,赤芍,姜黃,威靈仙等,加入路路通,其效立見 
  • 產後乳汁不通,虛証,應補益氣血;實証,則宜通利,必見乳房脹痛,乳汁難下,此時用路路通,其效不在王不留行,穿山甲,通草之下
  • 婦女痛經,多見氣滯瘀血之証,常用川芎,當歸,赤芍,柴胡,香附,澤蘭,益母草等,路路通既可行氣,又可活血,配用之可提高療效
  • 水腫亦可用路路通,本品兼有行氣,活血,利尿之效,本品能搜逐伏水,水伏之處,必有瘀血滯氣
  • 路路通為通利之物,不可重用,久用,以免耗氣傷陰,孕婦及虛人應慎用

2019年8月5日星期一

食物的營養成分及保健功效 - 海蜇

海蜇

適宜:中老年急慢性支氣管炎,見咳嗽哮喘,痰多黃稠者;高血壓病,見頭昏腦脹,煩熱口渴,大便秘結者。

不宜:脾胃虛寒者

營養成分:含蛋白質,脂肪,碳水化合物,鈣,磷等。

保健功效:味甘,鹹,性平,入肝,腎,肺經,可清熱平肝,化痰消積


2019年8月4日星期日

Diseases of the submandibular gland (下頜下腺疾病)

The superficial portion of the gland lies on the mylohyoid muscle; the deep portion extends around the posterior edge of muscle into the floor of the mouth. Wharton’s duct leaves the deep part of the gland and runs forward to open into the anterior floor of the mouth, just lateral to the midline.

Swelling of the gland may be due to inflammation or tumour.


Inflammatory diseases

Clinical features:
A tense, tender swelling usually results from a stone in the duct. This may be palpable bi-manually or evident on X-ray. There are several lymph nodes in the submandibular triangle and enlargement of these may mimic disease in the gland.

Management:
Treatment is with antibiotics and excision of the stone perorally. If this cannot be achieved , the whole gland may need to be removed by an external approach. Established infection may proceed to abscess formation.


Tumours
Fine-needle aspiration of the mass should be performed. About 50% of tumours are benign, most commonly pleomorphic adenomas.

Management:
These should be excised with the entire gland, taking care to preserve the marginal mandibular branch of the facial nerve. Malignant tumours necessitate excision of the whole gland, with a radical neck dissection in certain cases.


2019年8月3日星期六

食物的營養成分及保健功效 - 鮑魚

鮑魚

適宜:高血壓,糖尿病,更年期綜合徵,甲狀腺功能亢進患者,精神不易集中者

不宜:痛風,感冒,發熱,喉嚨痛者

營養成分:含豐富蛋白質,脂肪及較多的鈣、鐵、碘及維他命A等營養成分。

保健功效:味甘,鹹,性平,可養血,柔肝,滋陰,養顏,清熱,益精,明目等,對高血壓,肥胖症,大便秘結及女性月經不調均有一定的食療功效。
鮑魚肉中含有一種被稱為「鮑素」的成分,可破壞癌細胞必需的代謝物質,故有防癌抗癌的作用。


2019年8月2日星期五

Diseases of the floor of the mouth (口底疾病)

Anatomy:
Formed largely by the anterior two-thirds of the tongue and by reflection of mucosa from the sides of the tongue to the gum on the mandible. In the midline the lingual frenulum separates the orifices of the left and right submandibular ducts. Under the mucosa lie the sublingual salivary glands.


Ranula (舌下囊腫)
Aetiology:
A cystic lesion arising from the sublingual gland. Usually presents in the floor of the mouth as a bluish, fluctuant swelling. Less commonly the “plunging ranula” can present as a lump in the neck.

Treatment:
For lesions confined to the floor of the mouth, marsupialization is usually adequate, although recurrence can occur. Plunging ranulae require formal excision via an external neck approach.


Squamous carcinoma (鱗狀細胞癌)
Clinical features:
An ulcer in the floor of the mouth which may be painful with referred otalgia. Early spread to cervical nodes, which may be bilateral, is common.

Treatment:
Excision of the tumour with plastic surgical reconstruction and adjuvant radiotherapy.



2019年8月1日星期四

食物的營養成分及保健功效 - 蝦



適宜:骨質疏鬆,心血管疾病患者

不宜:過敏體質,氣喘,皮膚病患者

營養成分:含蛋白質,脂肪,碳水化合物,維他命A,維他命B1,維他命B2,維他命E,鈣,磷,鐵等。

保健功效:味甘性溫,可壯陽補腎,通乳袪毒,對腎虛腰酸,倦怠失眠,瘡癰腫毒,產婦缺乳等有輔助功效。



2019年7月31日星期三

Diverticula of the larynx and pharynx (喉部及咽部憩室)

Pharyngeal pouch (咽囊)

Aetiology:
A pharyngeal pouch develops from a herniation of pharyngeal mucosa through Killian’s dehiscence.

Clinical features:
Dysphagia and regurgitation of food occur. Large pouches may cause aspiration pneumonia. Pooling of saliva in the hypopharynx may be noted on indirect laryngoscopy. Barium swallow confirms the diagnosis.

Management:
Following an endoscopy to exclude an associated carcinoma, the pouch may be excised via an external approach or the wall between the pouch and oesophagus divided endoscopically using a stapling gun.


Laryngocele (喉膨出)

Aetiology:
Distension of the laryngeal saccule can produce an internal or external laryngocele.

Clinical features:
Hoarseness or dysphagia may occur. External laryngoceles may produce a swelling in the neck accentuated by performing Valsalva’s manoeuvre. Laryngeal tomograms taken during this manoeuvre will demonstrate the laryngocele.

Management:
Following endoscopy to exclude an associated carcinoma, an internal laryngocele can be ‘uncapped’ whilst an external laryngocele is excised through the neck.


2019年7月30日星期二

食物的營養成分及保健功效 - 海帶

海帶

適宜:癌症,甲狀腺腫大,糖尿病,心血管疾病患者

不宜:胃寒,甲狀腺功能亢進者,孕婦,腸胃炎患者

營養成分:含粗蛋白,脂肪,碳水化合物,粗纖維,鈣,鐵,碘,胡蘿蔔素,維他命B1,維他命B2,其中碘含量十分高。

保健功效:味鹹性寒,可降血壓,降膽固醇,防止動脈硬化,預防心腦血管疾病,增強免疫力,抗腫瘤等。

2019年7月29日星期一

Tracheostomy (氣管造口術)

A tracheostomy is an artificial opening made into the trachea. It may be created after the larynx has been removed, when it is permanent, or when the larynx is still in place, when it is usually temporary.

Indications:
  • Total laryngectomy
  • Airway protection, e.g. after major head and neck surgery, neurological disease involving the larynx
  • Airway obstruction, e.g. epiglottitis, bilateral recurrent laryngeal nerve palsy, tumour
  • Respiratory insufficiency (when endotracheal intubation required for longer than 72h) e.g. severe chest wall injury, Guillain-Barre syndrome

Surgical technique:
  • Incision, horizontal, midway between the cricoid cartilage and suprasternal notch.
  • Vertical incision and separation of strap muscles.
  • Transfixion and separation of thyroid isthmus.
  • Creation of an opening into the trachea. In adults a window is cut out. A vertical slit incision is used in children. A trap-door flap should not be used.
  • Insertion of tracheostomy tube. A correctly sized cuffed synthetic tube is used for the first 24h. this can be replaced later on by an uncuffed tube.

Complications:
  • Immediate. Pneumothorax, haemorrhage, surgical emphysema and tube displacement can all occur.
  • Early. Wound infection, dysphagia and tube obstruction are all common. Tracheal erosion with innominate artery rupture, perichondritis and apnoea in hypercapnoeic bronchitics are rare.
  • Late. Tracheal stenosis may result from prolonged or overinflation of the cuffed tube. Decannulation may be difficult in children. Surgical closure of a persistent tracheocutaneous fistula is rarely required after decannulation. 

Stomal stenosis (造瘻口狹窄)
Aetiology:Following laryngectomy the lower end of the trachea is brought out through the neck skin. Local wound infection, radiotherapy and keloid formation all predispose to the later development of a stomal stenosis. The other cause of stomal stenosis is recurrence of tumour.

Management:
Management of benign stomal stenosis is either by the permanent wearing of a stoma button or laryngectomy tube or by surgical revision of the stoma.


2019年7月28日星期日

食物的營養成分及保健功效 - 蔥



適宜:傷風感冒,發熱無汗,頭痛鼻塞,咳嗽痰多者,腹部受寒引起腹痛腹瀉者,胃寒之食欲不振,胃口不佳者,孕婦,頭皮多屑而癢者。

不宜:表虛多汗者,臭狐患者

營養成分:含豐富蛋白質,脂肪,碳水化合物,維他命A,維他命B1,維他命B2,維他命C,鈣,磷,鐵,鎂,膳食纖維等。

保健功效:味辛性溫,可通陽活血,驅蟲解毒,發汗解表,適用於風寒感冒輕症,癰腫瘡毒,痢疾,寒凝腹痛,小便不利等病症,對風寒感冒,頭痛,陰寒腹痛,蟲積內阻,痢疾等有較好的輔助治療作用。



2019年7月27日星期六

Congenital neck masses (先天性頸部腫塊)


Throglossal cyst (甲狀舌管囊腫)
Most common midline neck cyst usually presenting in childhood.

Clinical features:
Painless, unless infected, and moves on protrusion of tongue. Sinus formation may follow previous infection or incomplete excision.

Management:
If a thyroid scan shows functioning tissue elsewhere, then excise with central portion of hyoid bone and tract up to foramen caecum (Sistrunk’s operation).


Branchial cyst and fistula (鰓裂囊腫及瘻管)
Aetiology:
Represent branchial apparatus remnants. The fistula results from persistence of the second pouch and cervical sinus.

Clinical features:
Cysts usually lie deep to the anterior border of sternomastoid, presenting with a painless neck swelling or mimicking a parapharyngeal abscess if infection occurs. A complete branchial fistula has its internal opening in the region of the tonsil and an external opening anterior to sternomastoid. Diagnosis can be confirmed by needle aspiration of cyst contents.

Management:
Excision, with any fistulous tract.


Cystic hygroma (水囊狀淋巴管瘤)
A variety of lymphangioma.

Clinical features:
A soft transilluminable mass usually presenting in the parotid region in the first year of life.

Management:
Excision, which may have to be incomplete because of the diffuse infiltration of soft tissues by the tumour.



2019年7月26日星期五

食物的營養成分及保健功效 - 紹菜

紹菜

適宜:慢性習慣性便秘,傷風感冒,肺熱咳嗽,咽喉發炎,腹脹及發熱者

不宜:腹瀉者,氣虛胃寒者,胃腸功能不佳者

營養成分:含豐富膳食纖維,維他命B雜,維他命C,胡蘿蔔素,鈣,鐵,鉀等。

保健功效:性質寒涼,對防治感冒和發熱咳嗽有效。其膳食纖維可刺激腸胃蠕動,有助排出留在腸胃中的食物殘渣,可清除體內毒素。亦有助緩解頭痛,腹部脹痛等。



2019年7月25日星期四

Upper aerodigestive tract foreign bodies (上呼吸消化道異物)

Oropharynx (口咽)
Fish bones may lodge in the tonsil or tongue base.

Clinical features:
The patient complains of pain on swallowing and points to the suprahyoid region. The bone may only be obvious on palpation: X-rays are unhelpful.

Management:
Removal under direct vision.


Hypopharynx/oesophagus (下咽/食管)
A bone or food bolus usually gets lodged at one of four sites:
  • One piriform fossa
  • The postcricoid region (15cm from the upper incisor)
  • The level of the aortic arch (at 25cm)
  • At the oesophago-gastric junction (40cm)
Clinical features:
Dysphagia may be total, the patient spitting out saliva and pointing to the suprasternal or retrosternal region. A soft tissue lateral X-ray of the neck may delineate a bone.

Management:
Endoscopic removal should be undertaken as soon as possible, to avoid airway oedema, soft tissue infection or oesophageal perforation.


Bronchus (支氣管)
Often a peanut in a young child.

Clinical features:
After an initial coughing fit there is often a latent period before respiratory distress becomes obvious. The chest X-ray may show collapse of the lung distally, if the obstruction is complete, or emphysema of the involved side if the obstruction acts as a one-way valve.

Management:
Bronchoscopic removal is mandatory.


2019年7月24日星期三

食物的營養成分及保健功效 - 白菜

白菜

適宜:肺熱咳嗽,便秘,瘡癤等患者

不宜:脾胃虛寒,大便稀爛者

營養成分:含蛋白質,脂肪,糖類,膳食纖維,鈣,磷,鐵,胡蘿蔔素,維他命B1,維他命B2,維他命C等,其中鈣的含量較高。

保健功效:味甘性涼,入肺,胃,大腸經,可清熱除煩,行氣袪瘀,消腫散結,通利腸胃等。


2019年7月23日星期二

Laryngeal Tumours (喉腫瘤)

Papilloma (乳頭狀瘤)
Aetiology:
Localized infection with human papillomavirus (HPV).

Clinical features:
  • In the child (juvenile form): multiple lesions that may spread to the trachea and bronchi. Cases may regress at puberty.
  • In the adult: less common and usually a single lesion.
Both forms present with hoarseness or airway obstruction.

Management:
Endoscopic removal using either suction diathermy or a CO2 laser. Surgical seeding of lesions within the larynx or trachea is common, and removal may be necessary for frequent recurrence.


Carcinoma (癌)
Aetiology:
Associated with cigarette smoking and high alcohol intake, although the latter is more important in causing piriform fossa carcinoma.

Clinical features:
Usually presents as persistent hoarseness. Dysphagia, chronic cough, stridor and referred otalgia may also occur. Occasionally a supraglottic tumour may present with metastatic neck nodes. The tumour may be evident on indirect laryngoscopy but endoscopic assessment and biopsy are mandatory before deciding on the appropriate treatment. A second primary (1%) in the upper aerodigestive tract should be searched for at this time.

Fine-needle aspiration cytology of any suspicious neck mass should also be undertaken. A CT scan will show any spread outside the larynx, or involvement of laryngeal cartilages.

Management:
Small (T1 and T2) carcinomas are best treated with primary radiotherapy, laryngectomy being reserved for post-radiation recurrences, larger (T3 and T4) lesions and primary tumours associated with neck nodes greater than 2cm in diameter. Primary endoscopic excision of laryngeal carcinomas with a carbon dioxide laser is now being undertaken by some surgeons.


Voice rehabilitation:
Following total laryngectomy the patient may be able to speak again by:
  • Learning oesophageal speech (swallowed air is voluntarily regurgitated through the pharynx)
  • Using an artificial larynx, which transmits vibrations into the pharynx and oral cavity while the patient articulates
  • Surgical provision of a tracheo-oesophageal fistula, which is fitted with a button or valve. The button has a one-way flutter valve, which allows airflow from the trachea into the pharynx when the tracheostome is occluded. In selected patients this enables the development of good voice.

Results:
Patients require close follow-up. Recurrences can develop in the larynx, pharynx, stoma or neck. Further surgery or radiotherapy may be indicated. The expected 5-year survival for a T1 laryngeal cancer is about 95%. This falls to about 50% for T4 disease.



2019年7月22日星期一

風癩「抓狂」 呷醋止痕傷胃灼食道【明報專訊】2019-7-22



風癩「抓狂」 呷醋止痕傷胃灼食道【明報專訊】2019-7-22

【明報專訊】風癩(或稱風疹)驟起驟退,皮膚突然泛起一團團紅腫,愈抓愈癢,愈癢愈抓,令人「抓狂」。網上出現不少偏方,有指以醋外敷患處,可達止痕之效,亦有人提倡內服蒜醋,能快速消疹。

《本草求真》記載醋入肝經,散瘀解毒。中醫亦指出,醋對皮疹雖有一定收斂作用,但外塗或會刺激皮膚出現過敏反應,內服則刺激腸胃,甚至有灼傷食道的風險。


歎冷氣吃生冷食物誘發 驟起驟退
炎熱天,大家都躲在冷氣間避暑,又多吃生冷食物,卻未知以上習慣或會誘發風癩。註冊中醫石敏棋表示,風癩即為風疹、癮疹,發病時皮膚出現風團,泛紅或蒼白色,驟起驟退,「來得快、退得快」。她指出,有別濕疹,風癩的風團發無定處,游走性高,消退後一般不會留有疤痕。

風癩有不同類型之分,病因亦有所不同。註冊中醫何慧潔表示,風癩可分為3種證型,當中風寒束表及風熱犯表均屬急性風癩:
  • 風寒束表:風團偏淡色,患者多為常吹冷氣或進食生冷食物,致風邪進入身體,氣血不能正常運作,繼而發為風團
  • 風熱犯表:風團顏色偏紅,痕癢較劇烈,發作時皮膚會感到灼熱,患者多為進食發物,如牛肉、羊肉、海鮮等,引致皮膚過敏,誘發風癩


風癩亦有慢性,石敏棋表示,血虛風燥型的患者病程較長,風團容易反覆發作,每當氣候轉變、午後及夜間,病情便會惡化。她表示,部分患者同時有手足心發熱、煩躁、倦怠等徵狀。臨牀經驗所見,每逢轉季,為風癩患者發作的高峰期,料與環境溫度及濕度變化有關。


蒜醋久放招菌 外敷易過敏
儘管風癩快來快去,不留疤痕,但發作時痕癢非常,不少患者尋找偏方,希望立即消痕消腫。網上流傳以醋治風癩,把水混合蘋果醋,外敷患處;亦有人建議自製蒜醋每天外塗內服,聲稱能止痕消疹。到底醋是否治風癩的良藥?

石敏棋表示,醋能活血散瘀,解毒療瘡,且可消腫,古書《本草求真》曾記載「酸主斂,故書多載散瘀解毒,下氣消食。」她指出,醋味酸,主入肝經,具收斂固澀之效,因此治療皮疹上,有一定的收斂作用。她補充,醋同時能抗感染,抑制細菌,「不排除醋能夠為風癩患者止痕,因為醋本身有消炎作用」。

但對於風癩患者應否內服醋,石敏棋有所保留。她指出,醋的酸鹼值(pH)與胃酸相近,胃酸過多或胃腸道潰瘍患者若內服醋,或會刺激胃腸道黏膜,引致胃部不適。她引述2002年《香港醫學雜誌》一個案指出,一名女性為了溶解卡在喉嚨的蟹殼,服用了一湯匙白醋,其後口咽發炎,食道出現腐蝕傷害;證實飲用醋會灼傷食道。

參考連結:



2019年7月21日星期日

Chronic laryngitis (慢性喉炎)

Chronic non-specific laryngitis (慢性非特異性喉炎)
Aetiology:
Common. Usually associated with vocal abuse, smoking or sepsis elsewhere in the respiratory tract, e.g. chronic sinusitis.

Clinical features:
Hoarseness may be accompanied by sore throat. Indirect laryngoscopy may distinguish localized forms, e.g. singer’s nodules, Reinke’s oedema or laryngeal polyps, from the generalized forms, e.g. chronic hypertrophic laryngitis.

Management:
Treatment involves the removal of any precipitating factors and speech therapy is important. Localized polyps or nodules may merit endoscopic removal.


Chronic specific laryngitis (慢性特異性喉炎)
Rare. Most of the granulomatous diseases can involve the larynx, e.g. tuberculosis, syphilis, sarcoidosis, scleroma or Wegener’s granulomatosis.

Management:
The lesions may mimic a carcinoma and a direct laryngoscopy and biopsy is mandatory. Treatment is that of the underlying systemic condition.


Leukoplakia (聲帶白斑)
Usually affects the true cords. The aetiology is as for chronic non-specific laryngitis. Microscopically, the findings of hyperkeratosis and dysplasia are common, although in situ or invasive carcinoma can only be excluded by an adequate biopsy.

Management:
Endoscopy should be undertaken in all cases. Leukoplakia should be regarded as having the potential to undergo malignant change.


2019年7月20日星期六

食物的營養成分及保健功效 - 芫荽

芫荽

適宜:風寒外感,食欲不振者,小兒出麻疹者

不宜:患口臭,臭狐,嚴重蛀牙,胃潰瘍者,麻疹已透或雖未透出而熱毒壅滯者。

營養成分:含蛋白質,糖類,膳食纖維,維他命C,胡蘿蔔素,鈣,磷,鎂,鉀,鐵等。

保健功效:味辛性溫,入肺,脾經,可芳香健胃,袪風解毒,適用於食積氣滯,食欲低下,胃脹,腹部冷痛,麻疹不透等,對流行性感冒有一定防治作用。



2019年7月19日星期五

Clinical examination of the larynx (喉部臨床檢查)

If symptoms of hoarseness, dysphagia, chronic sore throat or a lump in the neck continue for longer than 6 weeks, careful examination of the upper airway is mandatory.

Listen to the patient’s voice: is it intermittently or permanently dysphonic? 

The former might suggest a functional problem, the latter an organic one. A breathy voice is a typical of a vocal cord palsy. Also, listen for evidence of stridor. A “hot potato” voice is indicative of supraglottic or oropharyngeal pathology.

When assessing the oral cavity and oropharynx, particular attention should be paid to mucosal ulceration or swelling. If the patient has a particularly brisk gag reflex, the palate and oropharynx should be sprayed with Lidocaine prior to attempting indirect laryngoscopy. 

A warmed laryngeal mirror is used to visualize the larynx while the doctor gently holds the patient’s protruded tongue. The patient should mouth breathe. Vocal cord movement is assessed by asking the patient to say “Hey!” or “eeee…”. If the technique is not tolerated, then the patient’s better nasal airway is locally anaesthetized and a fibre-optic scope is used to examine the larynx and pharynx.

Both the nose and neck should be routinely examined as part of the assessment of the upper airway.


2019年7月18日星期四

食物的營養成分及保健功效 - 通菜

通菜

適宜:便血,尿血和鼻血患者,糖尿病,高膽固醇,高脂血症患者及口臭者。

不宜:體質虛弱,脾胃虛寒,血壓偏低,大便稀爛者。

營養成分:含蛋白質,維他命A,維他命B2,維他命C,鈣,鐵,磷,鉀,鈉,銅,鎂等。

保健功效:味甘性涼,入胃,腸經,可潤腸通便,清熱涼血,療瘡解毒等,適用於便秘,血尿,便血,熱淋,癰瘡腫毒等。



2019年7月17日星期三

Tumours of the tonsil (扁桃體腫瘤)

Benign cysts (良性囊腫)
Clinical features:
Mucous retention cysts, tonsilloliths or cysts of inspissated epithelial debris may occur. They are smooth and localized to one portion of the tonsil.

Management:
Symptomatic cysts may be helped by tonsillectomy.


Lymphoma (淋巴瘤)
Clinical features:
Unilateral tonsillar swelling with an intact overlying mucosa may cause dysphagia and is suspicious of a lymphoma. The tonsil feels rubbery. Excision biopsy confirms the diagnosis.

Management:
After staging the disease, treatment involves radiotherapy for localized disease, with chemotherapy being added in more advanced cases.


Carcinoma (癌)
Clinical features:
Squamous carcinoma of the tonsil presents as otalgia, sore throat or dysphagia in heavy drinkers and smokers. More than 50%of cases have involved neck nodes ipsilaterally: this may be the mode of presentation. The tonsil is hard and ulcerated.

Management:
After full endoscopy and biopsy small primaries without nodes are best treated by radiotherapy. Surgery (which involves a block dissection of neck, partial mandibulectomy and excision of the primary) is reserved for radiation failures and large primaries. 


2019年7月16日星期二

食物的營養成分及保健功效 - 南瓜

南瓜

適宜:肥胖者,糖尿病患者和中老年人

不宜:胃熱腹滿,氣滯濕阻,腳氣,黃疸患者

營養成分:含蛋白質,碳水化合物,葫蘆鹼,南瓜子鹼,胡蘿蔔素,維他命B1,維他命B2,維他命B12,維他命C,維他命E,葉酸,果膠,葡萄糖,鈣,鎂,鉀,鋅等。

保健功效:味甘性溫,可補中益氣,潤肺化痰,消炎止痛,解毒殺蟲,常用於輔助治療哮喘,燒傷燙傷等,對糖尿病,肝炎,肝硬化,腎炎,高脂血症有食療作用。



2019年7月15日星期一

Leukoplakia and tongue carcinoma (舌白斑和舌癌)

Leukoplakia (舌白斑)
A white patch which cannot be wiped away and for which no other diagnosis is apparent. Risk factors in the development of oral cavity or tongue leukoplakia include alcohol, smoking, spice and betel nut chewing, syphilis and dental trauma. About 5% of cases become malignant. Exclusion of an associated carcinoma is essential.


Tongue carcinoma (舌癌)
Almost all tongue carcinomas are squamous in origin. There need not be any pre-existing leukoplakia.

Clinical features:
May present as an exophytic or infiltrative lump on the tongue. Pain and dysphagia are common. Referred otalgia (via lingual and glossopharyngeal nerves) may also occur. At presentation most tumours are greater than 2cm diameter and 50% have palpably involved lymph nodes.

Management:
Small lesions  Radiotherapy, using external beam or interstitial implant techniques, or surgery, in the form of a partial or hemiglossectomy are equally effective.

Large lesions – Treatment is with radiotherapy or surgery alone or a planned combination of the two. Both modalities produce quite severe functional disability in the oral cavity, especially regarding speech and swallowing.


2019年7月14日星期日

食物的營養成分及保健功效 - 青瓜

青瓜

適宜:肥胖病,高膽固醇,動脈硬化,糖尿病患者

不宜:肝病,心血管病,腸胃病,慢性支氣管炎患者

營養成分:含蛋白質,碳水化合物,維他命A,維他命B雜,維他命C,纖維素,鈣,磷,鐵,鉀等。

保健功效:味甘性涼,可清熱解毒,有助降低膽固醇,對咽喉腫痛有一定輔助療效,還可滋潤皮膚,防治毛孔堵塞。




2019年7月13日星期六

Nasal airway obstruction in children (兒童鼻氣道阻塞)

Nasal obstruction in children is usually noted by parents,, particularly when accompanied by rhinorrhea and snoring. Adenoid hypertrophy is the common cause of pediatric nasal obstruction. However, the following conditions should also be borne in mind.


Posterior choanal atresia (後鼻孔閉鎖)
Aetiology:
A congenital condition caused by persistence of the embryonic bucconasal membrane. The obstruction is at the posterior end of the nose near the edge of the hard palate.

Clinical features:
In bilateral cases there is respiratory difficulty at birth aggravated by feeding and necessitating the use of an oral airway. Unilateral cases present later with unilateral nasal obstruction and rhinorrhea. Diagnosis is made by the inability to pass a rubber catheter through the nose into the pharynx and is confirmed by CT scanning.

Management:
Surgical division of the atretic plate by the transnasal or transpalatal route is required.


Nasal foreign body (鼻腔異物)
A common occurrence in children, e.g. with beads, pieces of sponge or paper.

Clinical features:
Typically presents with unilateral foul blood-stained rhinorrhea, nasal vestibulitis and fetor.

Management:
A general anesthetic is occasionally required for removal in an uncooperative child.


2019年7月12日星期五

食物的營養成分及保健功效 - 菠菜

菠菜

適宜:體弱病者,年老幼兒,電腦工作者,糖尿病者(尤其II型),高血壓,便秘,貧血,壞血病患者,皮膚粗糙者,過敏者。

不宜:腸胃虛寒,腹瀉者,腎炎,腎結石患者,脾虛大便爛者

營養成分:含蛋白質,脂肪,碳水化合物,纖維素,類胡蘿蔔素,維他命B1,維他命B2,維他命C,維他命E,磷,鐵等

保健功效:味甘性涼,可利五臟,活血脈,通腸胃,開胸膈,滋陰補血,對腸胃失調,便秘,便血,貧血,高血壓等有食療作用,常吃菠菜可預防口腔炎症及皮炎。



2019年7月11日星期四

Otitis externa (外耳道炎)

Definition:
Inflammation of the skin of the external auditory meatus.

Aetiology:
Caused by either primary infection or contact sensitivity to topically applied substances such as cosmetics or antibiotics. Gram-negative organisms (e.g. Proteus, Pseudomonas) and fungi (e.g. Aspergillus) are often found. 
Precipitating factors include impacted cerumen, local trauma, middle ear discharge through a tympanic membrane perforation, swimming and skin conditions such as psoriasis and seborrheic dermatitis.

Clinical features:
Presents as otalgia, otorrhoea and deafness. The skin of the external auditory meatus is oedematous and inflamed. The meatus may be occluded with discharge and in fungal infections hypae may be seen. Traction on the pinna increases the otalgia, a sign not found in inflammatory conditions of the middle ear.

Management:
Debris must be removed from the meatus, either by dry mopping or by suction aided by the use of an operating microscope. A swab of the meatus is taken for bacteriology prior to the instillation of drops containing an antibiotic and steroid mixture. If the meatus is total occluded, an impregnated gauze wick may be inserted. In severe cases with cellulitis spreading onto the pinna systemic antibiotics are also needed.


Furunculosis of the external auditory meatus (外耳道癤)
Staphylococcal infection of hair follicles found in the lateral part of the meatus.

Clinical features:
Presents as severe otalgia exacerbated by traction on the pinna, with deafness if the meatus becomes occluded. The furuncle is often visible.

Management:
Most furuncles rupture spontaneously. Ribbon gauze impregnated with glycerin/ichthammol may be inserted daily into the meatus. Systemic flucloxacillin and analgesics are also needed.


Necrotizing (malignant) otitis externa (壞死性/惡性外耳炎)
A potentially fatal Pseudomonas infection of the external auditory meatus, with spread to the skull base. It occurs in elderly diabetics and also in patients with HIV/AIDS.

Clinical features:
Presents as severe otalgia, otorrhoea and deafness with progression to cranial nerve palsies (VII, IX, X, XI, XII) in advanced cases.

Management:
Treatment is by local surgery, usually mastoidectomy, combined with a prolonged course of specific antipseudomonal antibiotics. Skull base involvement and its response to treatment may be assessed by radioisotope scanning.


2019年7月10日星期三

食物的營養成分及保健功效 - 茄子

茄子

適宜:高血壓,動脈硬化,咯血,紫斑症,壞血病等患者

不宜:慢性腹瀉,消化不良者

營養成分:含蛋白質,脂肪,碳水化合物,維他命及鈣,磷,鐵等多種礦物質。

保健功效:味甘性寒,可通絡化瘀,消腫止痛,增強毛細血管性,防止微血管破裂出血,保持血小板正常功能,促進傷口愈合,對高血壓,動脈硬化,咯血,紫斑症等有一定預防作用。


2019年7月9日星期二

Diseases of the external nose (外鼻疾病)

Rhinophyma (肥大性酒渣鼻)
Clinical features:
Red nodular masses centred around the nasal tip in association with acne rosacea, usually seen in elderly men.

Management:
If unsightly, treat by dermabrasion or surgical shaving.


Lupus vulgaris (尋常狼瘡)
Aetiology:
Inoculation of the bacterium Mycobacterium tuberculosis, possibly through nose picking.

Clinical features:
Red/brown patches or nodules on the nasal or facial skin. Perforation of the cartilaginous nasal septum can occur, with scarring in long-standing cases.

Management:
Treatment is by antituberculous chemotherapy.


Lupus pernio (凍瘡樣狼瘡)
Clinical features:
Skin lesions other than erythema nodosum occur in 20% of patients with sarcoidosis. Lupus pernio is common and is frequently associated with bone cysts and chest disease.

Management:
Treat the underlying disease.


Malignant tumours (惡性腫瘤)
Clinical features:
Basal or squamous cell carcinomas present as warty or ulcerating lesions, rarely with lymphadenopathy. Melanomas are more rare.

Management:
Excision biopsy when possible; radiotherapy for larger tumours not involving bone. 



2019年7月8日星期一

食物的營養成分及保健功效 - 大蒜

大蒜

適宜:流行性感冒,傷寒,痢疾,肺病,寄生蟲病患者

不宜:陰虛火量,眼疾,胃潰瘍,慢性胃炎患者。生蒜不宜食用過多,尤其是胃功能不佳者。

營養成分:含蛋白質,脂肪,碳水化合物,鈣,磷,鐵,多種維他命,膳食纖維,揮發油等。

保健功效:味辛性溫,可健胃,殺菌,散寒,袪風濕,健脾胃,特別適合肺病患者食用。大蒜所含揮發油是硫化物的混合體,有特異氣味,其中所含的二硫化合物和蒜辣素有殺菌驅蟲作用,可用於防治流行性感冒,傷寒,霍亂,痢疾及寄生蟲病。


2019年7月7日星期日

Neck space infections (頸部間隙感染)

Acute retropharyngeal abscess (急性咽後膿腫)
Lymphadenitis of the retropharyngeal nodes following an upper respiratory tract infection in children.

Clinical features:
Presents with sore throat, pyrexia and swelling of the posterior pharyngeal wall. Lateral X-ray shows retropharyngeal swelling.

Management:
The abscess should be drained via the mouth with precautions taken to avoid inhalation of pus.


Chronic retropharyngeal abscess (慢性咽後膿腫)
Occurs in adults in association with tuberculous cervical spine disease.

Clinical features:
Swelling is seen in the midline of the pharynx and X-rays show vertebral disease.

Management:
Treatment is with antituberculous chemotherapy.


Parapharyngeal abscess (咽旁膿腫)
The tissue space lateral to the pharynx may become infected by spread of organisms from the tonsils or lower third molar teeth.

Clinical features:
Presents with sore throat and trismus. The tonsil is pushed medically and there is neck swelling.

Management:
Treatment is by incision and drainage via the neck followed by appropriate antibiotic therapy.


Ludwig’s angina (Ludwig咽峽炎)
Clinical features:
Cellulitis of the submandibular space secondary to dental disease or tonsillitis presents with swelling of the submental region and floor of the mouth.

Management:
Treat with high-dose antibiotics. 


2019年7月6日星期六

食物的營養成分及保健功效 - 生姜

生姜

適宜:傷風感冒,寒性痛經,暈車暈船者

不宜:陰虛內熱,邪熱亢盛者。吃姜不宜過多,以免吸收大量姜辣素,經腎臟排泄過程中可刺激腎臟,可產生口乾咽痛,便秘等上火症狀。

營養成分:含碳水化合物,姜油,水茴香,樟腦等。

保健功效:味辛性微溫,可發汗解表,溫中止嘔,溫肺止咳,袪風解毒,促進血液循環,用治於頭痛,咳嗽,外感風寒,胃寒嘔吐,腹痛腹瀉,中魚蟹等。



2019年7月5日星期五

Acute tonsillitis (急性扁桃體炎)

Incidence:
A very common disease particularly affecting children between the ages of 4 and 10 years.

Aetiology:
Over 50% of the cases are due to a B haemolytic streptococcus, the majority of the others being of viral, staphylococcal or pneumococcal origin.

Clinical features:
Sore throat, dysphagia, pain on swallowing and otalgia are associated with pyrexia and general malaise. The pharyngeal mucosa appears red and the tonsils are often enlarged and covered by discrete microabscesses or a confluent exudate. 
The tonsils often remain chronically enlarged and inflamed. Lymphadenopathy is frequent, the jugulo-digastric nodes being most commonly involved. A full blood count reveals a leukocytosis but a bacteriology swab does not always grow the pathogen concerned.

Differerntial diagnosis:
  • Infectious mononucleosis – it may be impossible to distinguish between the two without a Paul-Bunnell test and a differential white cell count (the latter shows atypical monocytes and a lymphocytosis).
  • Blood dyscrasias – any white cell abnormality giving an impaired immune status may present as a severe pharyngitis, e.g. acute leukaemia.
  • Diphtheria – rarely seen but should always be borne in mind when there is a membranous exudate over the tonsils or when severe airways obstruction is evident.

Management:
Bed rest, antibiotics and adequate hydration. Penicillin is given (orally or intravenously) unless organism sensitivities or allergy dictate otherwise. In severe cases with grossly enlarged tonsils a tracheostomy may be necessary for airway obstruction.
Recurrent episodes over a prolonged period of time are best managed by tonsillectomy. Following surgery the tonsillar fossae heal over a period of 7-10 days during which time they are covered by a slough, which may mimic an ulcerative pharyngitis. Infection and secondary haemorrhage from the fossae can occur during this period.

Complications:

Chronic tonsillitis
  • Peritonsillar abscess (quinsy): hospitalization, antibiotics and intraoral incision and drainage are required
  • Parapharyngeal abscess: requires surgical drainage through an external neck incision

Acute otitis media
Post-streptococcal rheumatic fever/glomerulonephritis: now rare. 


2019年7月3日星期三

Laryngeal obstruction in children (兒童喉阻塞)

Clinical features:
The hallmark of laryngeal obstruction is stridor. Inspiratory stridor indicates glottic or supraglottic obstruction, expiratory stridor bronchial obstruction and two-way stridor subglottic obstruction. If stridor is accompanied by cyanosis, tachycardia and intercostal and sternal recession, urgent measures are needed to save life. In less severe cases a hoarse voice, feeding problems and recurrent chest infections may occur.


Congenital laryngeal obstruction (先天性喉阻塞)

Aetiology:
Congenital anomalies include laryngeal cysts, webs, stenosis, vascular rings and vocal cord paralysis. Laryngomalacia is a condition caused by abnormal flaccidity of the larynx allowing the supraglottic structures to be drawn into the airway on inspiration; the condition resolves with age.

Management:
All cases of congenital stridor should undergo direct laryngoscopy.


Acquired laryngeal obstruction (後天性喉阻塞)

Aetiology:
  • Acute epiglottitis – due to Haemophilus influenzae. It causes rapidly progressive airway obstruction.
  • Acute laryngotracheobronchitis (croup) – due to para-influenzae virus or respiratory syncytial virus. It produces oedema, exudates and crusting of the larynx, trachea and bronchi.
  • Subglottic stenosis – may follow infant tracheostomy or prolonged endotracheal intubation.

Management:
  • Acute epiglottitis – treatment is with intravenous chloramphenicol. Endotracheal intubation or an emergency tracheostomy may be necessary.
  • Acute laryngotracheobronchitis – endotracheal intubation is rarely required.

2019年7月2日星期二

食物的營養成分及保健功效 - 紅蘿蔔

紅蘿蔔

適宜:消化不良,夜盲症,痢疾,高血壓,糖尿病等患者

不宜:過量食用可令皮膚發黃,停食可消除

營養成分:含豐富類胡蘿蔔素,蛋白質,脂肪,碳水化合物,維他命B 雜,維他命C等。

保健功效:味甘性平,可健脾化滯,潤燥明目,增進食欲,抗癌等,可保護眼睛和皮膚健康,提高機體免疫力,對消化不良,夜盲症,痢疾,高血壓,糖尿病等均有一定食療作用。


2019年7月1日星期一

Paranasal sinus tumours (鼻竇腫瘤)

Pathology:
  • Benign tumours – include papillomas, adenomas, osteomas and angiomas. The inverting papilloma may undergo malignant change.
  • Malignant tumours – 50% of malignant tumours are found in the maxillary sinus. Squamous cell carcinoma is the most common type. Others include adenocarcinoma, adenoid cystic carcinoma, melanoma and sarcoma.

Clinical features:
Benign tumours frequently present as a unilateral nasal polyp. Malignant tumours spread medically to produce nasal obstruction or epistaxis, posteriorly to give Eustachian tube obstruction and cranial nerve palsies, inferiorly to disrupt the teeth to give proptosis or epiphora. Lateral spread produces swelling of the cheek.


Management:
Prior to treatment planning, histological diagnosis and radiological assessment of the extent of the tumour using CT scanning and sinus tomography are necessary. Benign tumours are treated by local extension, either endoscopically or by an external lateral rhinotomy approach. 
Malignant tumours have a poor prognosis due to their late presentation and extensive spread. When curative treatment is possible a combination of radical surgery (maxillectomy) and radiotherapy is usually used. The resulting defect is filled with a dental plate and obturator.


2019年6月30日星期日

食物的營養成分及保健功效 - 蘆筍

蘆筍

適宜:癌症患者

不宜:痛風及尿酸偏高者

營養成分:含蛋白質,碳水化合物,多種維他命和氨基酸,鎂,錳等微量元素等

保健功效:味甘性寒,可健脾益氣,滋陰潤燥,生津解渴,對各種癌症有預防和治療作用。



2019年6月29日星期六

Tumours of the nasopharynx (鼻咽部腫瘤)

Angiofibroma (鼻咽血管纖維瘤)

Incidence:
A benign vascular tumour occurring in males under the age of 25 years.

Clinical features:
Nasal obstruction, epistaxis and deafness due to middle ear effusion are common characteristics.

Management:
Treatment is by surgical excision, facilitated by preoperative CT scanning, arteriography and embolization.


Malignant tumours (惡性腫瘤)

Incidence:
Common in south east Asia, where they account for 20% of all malignant tumours.

Clinical features:
Present as nasal obstruction, epistaxis and deafness. Metastasis to cervical nodes may occur prior to local symptoms becoming apparent. Cranial nerve palsies occur in advanced cases.

Pathology:
Most are squamous carcinomas, although anaplastic carcinomas and lymphomas also occur.

Management:
Radiotherapy following biopsy confirmation, with surgery used only for cervical nodes not responding to irradiation.


Chordoma (脊索瘤)

A very rare locally invasive neoplasm arising from remnants of the fetal notochord found in the skull base. Presents with neurological, nasal and ophthalmic symptoms.


2019年6月28日星期五

食物的營養成分及保健功效 - 絲瓜

絲瓜

適宜:月經不調,身體疲乏,痰喘咳嗽,大便乾燥者,產後乳汁不通婦女

不宜:體虛內寒,腹瀉大便爛者

營養成分:含蛋白質,脂肪,碳水化合物,鈣,磷,鐵,維他命B雜,維他命C等。

保健功效:味甘性平微寒,可袪風濕,通經絡,清熱利咽,化痰止咳,涼血解毒,清熱利腸,生津止渴,解暑除煩,可防治壞血病,促進小兒大腦發育及保護中老年大腦健康的作用。



2019年6月27日星期四

Adenoids (腺樣體)

Lymphoid tissue found at the junction of the roof and posterior wall of the nasopharynx, thought to be involved in the development of humoral immunity as a component of the “gut associated lymphoid tissue” (GALT). Adenoid tissue is present at birth and during childhood, beginning to atrophy before puberty.

Clinical features:
Adenoidal hypertrophy disturbs nasopharyngeal airflow and Eustachian tube function and can also act as a focus of infection for adjacent sites. Common clinical features are nasal obstruction and discharge, deafness due to middle ear effusion and otalgia due to recurrent otitis media. 
Gross adenoidal enlargement, often associated with tonsillar hypertrophy, can cause sleep apnoea syndrome in which apneic episodes during sleep are associated with daytime somnolence and in severe cases pulmonary hypertension and cor pulmonale. Clinical suspicion of enlarged adenoid can be confirmed by lateral radiography.

Management:
Surgical removal (adenoidectomy) can be undertaken if enlarged adenoids are causing sleep apnoea, nasal obstruction or are a contributing factor to persistent middle ear effusions or recurrent otitis media.


Non-infective rhinitis (非感染性鼻炎) - Atrophic rhinitis (萎縮性鼻炎)

Atrophic rhinitis (萎縮性鼻炎)

Aetiology:
A disease of unknown aetiology, occurring mainly in developing countries. It can occur following radical turbinectomy operations or radiotherapy to the nasal cavity.

Clinical features:
Nasal crusting, anosmia and fetor are present. Paradoxically, although the nasal cavity is widely patent, the sensation of nasal obstruction is common.

Management:
Treatment is by removal of crusts and nasal douches.


2019年6月26日星期三

食物的營養成分及保健功效 - 蓮藕

蓮藕

適宜:肝病,肺炎,便秘,糖尿病等患者,瘀血,吐血,尿血,便血等出血者

不宜:胃病,十二指腸潰瘍患者

營養成分:含豐富蛋白質,碳水化合物,纖維素,多種維他命及鈣,鐵,磷等,其中維他命C含量極高。

保健功效:生藕性寒,可生津涼血;熟藕性溫,可補脾益血。蓮藕止血作用強,對體內各種出血症都有較好的療效,常用於治療吐血,咳血,尿血,便血,子宮出血等症。還可預防糖尿病,高血壓,貧血,是養顏美容佳品。



2019年6月25日星期二

Non-infective rhinitis (非感染性鼻炎) - Non-allergic rhinitis (非應變性鼻炎)

Non-allergic rhinitis (非應變性鼻炎)

Clinical features:
Presents as chronic nasal obstruction and rhinorrhea with no demonstrable allergy.

Management:
If medical treatment in the form of antihistamine or steroid sprays fails to produce relief, nasal obstruction may be helped by surgical reduction or diathermy of the inferior turbinates. 
Long term use of sympathomimetic vasoconstrictor nasal sprays can result in chronic nasal congestion as a rebound effect: rhinitis medicamentosa.



2019年6月24日星期一

食物的營養成分及保健功效 - 薯仔 (馬鈴薯)

薯仔 (馬鈴薯)

適宜:胃病,濕疹,便秘等患者

營養成分:含蛋白質,脂肪,碳水化合物,類胡蘿蔔素,維他命B雜,維他命C,鈣,磷,鐵,鉀等。

保健功效:味甘性平微涼,可和胃調中,健脾利濕,解毒消炎,整腸通便,降糖降脂,活血消腫,益氣強身,美容抗衰老,對胃火牙痛,脾虛納少,大便乾結,高血壓,高血脂,消化不良,習慣性便秘,神疲乏力,慢性胃痛,關節疼痛,皮膚濕疹等症有一定輔助療效。



2019年6月23日星期日

Non-infective rhinitis (非感染性鼻炎) - Allergic rhinitis (應變性鼻炎)

Allergic rhinitis (應變性鼻炎)

Aetiology:
Hypersensitivity to inhaled or ingested allergens causes nasal mucosal oedema and exudation. Allergy may be seasonal (e.g. pollens) or perennial (e.g. dust). Allergies may be demonstrated by skin tests.

Clinical features:
Presents as nasal obstruction, sneezing and rhinorrhea with mucosal oedema on examination.

Management:
Treat with steroid nasal spray and oral antihistamines. Avoid any known allergens.



2019年6月22日星期六

食物的營養成分及保健功效 - 苦瓜

苦瓜

適宜:糖尿病,癌症患者,皮膚熱痱者

不宜:脾胃虛寒者

營養成分:含蛋白質,脂肪,糖類,纖維素,胡蘿蔔素,維他命B2,維他命C,苦瓜苷,鈣,鐵,磷等。其中,維他命C含量十分豐富。

保健功效:味苦性寒,可清暑袪熱,明目解毒,養血益氣,對熱病煩渴,中暑,痢疾,目赤,癰腫丹毒有一定的食療作用,常食苦瓜可降低血糖,增強機體免疫力,使皮膚細嫩柔滑。


2019年6月21日星期五

Diseases of the nasal septum (鼻中膈疾病) - Septal perforation (鼻中膈穿孔)

Septal perforation (鼻中膈穿孔)

Aetiology:
  • Traumatic – after septal surgery, nose picking, cocaine sniffing and pressure from foreign bodies and nasal polyps.
  • Infective – due to syphilis and tuberculosis.
  • Chronic inflammatory – Wegener’s granulomatosis is a non-neoplastic upper airways granuloma associated with focal lung and kidney lesions. (Lethal) midline granuloma is thought to be an atypical lymphoma occurring in the midline of the face.


Clinical features:
Asymptomatic, or nasal crusting and epistaxis are characteristic of septal perforation.

Management:
Treatment is by removal of crusts, nasal douches and treatment of underlying systemic conditions.


2019年6月20日星期四

食物的營養成分及保健功效 - 白蘿蔔

白蘿蔔

適宜:大便不暢,胃脹燒心,肥胖者

不宜:脾虛泄瀉,胃潰瘍,十二指腸潰瘍,慢性胃炎,單純甲狀腺腫,先兆流產,子宮脫垂等患者。

營養成分:含蛋白質,多種氨基酸,脂肪,葡萄糖,果糖,維他命C,鈣,多種酶類,揮發油等。

保健功效:含有促進新陳代謝的物質,有助於消除皮下脂肪,可有減肥作用。白蘿蔔中的揮發油和芥子油可刺激胃腸蠕動,幫助消化,增強食欲。



2019年6月19日星期三

Diseases of the nasal septum (鼻中膈疾病) - Septal abscess (鼻中膈膿腫)

Septal abscess (鼻中膈膿腫)

Aetiology:
Septal abscesses usually result from secondary infection of a septal haematoma.

Clinical features:
Manifests by the development of severe pain, nasal swelling and pyrexia following a septal haematoma. Cartilage necrosis often complicates septal haematoma and abscess with the production of a saddle-nose deformity.

Management:
Treatment is by incision and drainage with appropriate antibiotic therapy.



2019年6月18日星期二

食物的營養成分及保健功效 - 蕃茄

蕃茄

適宜:熱性病,發熱,口渴,食欲不振,牙齦出血,貧血,頭暈,心悸,高血壓,急慢性肝炎,急慢性腎炎,夜盲症患者

不宜:急性腸炎,菌痢及潰瘍活動期患者。

營養成分:含豐富維他命,蛋白質,脂肪,碳水化合物,鈣,鐵,磷,茄紅素等。茄紅素是一種不含氧的類胡蘿蔔素,可預防及改善前列腺增生,前列腺炎等泌尿系統疾病,保護心血管,提高免疫力,抗老化。

保健功效:生津止渴,清熱解毒,健胃消食,涼血平肝,對高血壓,夜盲症,乾眼症,腎病患者均有一定的食療作用,還可促進皮膚健康,預防口腔炎症,防癌抗癌,美白抗衰老等。



2019年6月17日星期一

Diseases of the nasal septum (鼻中膈疾病) - Septal haematoma (鼻中膈血腫)

Septal haematoma (鼻中膈血腫)
A collection of blood beneath the mucoperichondrium and posteriorly the mucoperiosteum of the nasal septum.


Aetiology:
Usually complicates nasal trauma, either accidental or iatrogenic following septal surgery. Rarely a spontaneous haematoma can occur in a bleeding diathesis.

Clinical features:
Presents as nasal obstruction with widening of the septum on inspection.

Management:
In the acute stage, treat by incision and drainage, however, after 48hrs, organization of haematoma occurs and evacuation of the clot is difficult. Antibiotics are given to prevent secondary infection.