摄于2007年1月3日清晨之前
作者:luna_zjb 日期:2006-12-31
累的
作者:luna_zjb 日期:2006-12-27
Dr. Freddie Mohs by Stephen N. Snow, MD
作者:luna_zjb 日期:2006-12-24
[size=4]Mohs surgery Changes the Face of Dermatology
“You can’t drive that car! It has no brakes.” Seventeen-year-old Freddie Mohs refused to heed his aunt’s caution. You see, “can’t” was not a word in his vocabulary even in 1927. And he had already figured out he could slow the car by downshifting the gears. That was Freddie all right. A little wild perhaps, but he grew up confident and what is more he trusted “his” own good judgment more than that of others. After all, “he “ was doing the driving.
He drove his high-school sweetheart on a 40-mile round-trip without mishap. When he was a bit older, he realized it had been a little foolhardy; nonetheless, the incident served to boost his self-confidence. His future bride, Mary Ellen Reynolds, trusted him and more important, believed in him. Freddie was imbued with strength of character and was not afraid of challenges that tested his principles. He went on to ignore objections and overcome all obstacles in developing a new form of surgery. Born amid controversy and skepticism, micrographic surgery was to revolutionize skin cancer treatment.
In the Beginning
Though many advances have come in the last 25 years, the development of what came to be Mohs surgery began in the mid 1930s, when Mohs, first as a medical student and the surgical resident, began to use the microscope to determine the margins of skin cancer. It took only two years to work out the microscopic technique, but more than 40 years passed before it was accepted by the medical establishment.
The first major step was taken when Dr.Mohs began experiments injecting various chemicals into rats to assess the response. He noted that the body’s immune cells were dense around normal issue but sparse around cancerous tissue. In addition, one of these chemicals, zinc chloride, preserved cellular details. This finding was the genesis of Mohs surgery. Dr. Mohs later pointed out that “this observation would ordinarily have gone unrecorded and unnoticed had it not initiated a train of thought that led to he concept of excising skin cancer under complete microscopic control.
Horizontal Sections Work Better
Dr. Mohs had many patients with large facial skin cancers that were difficult to treat. Before the Mohs technique was introduced, biopsies were frequently taken at random or specific intervals around the perimeter of the excision. This was unreliable because the in-between area escaped microscopic examination. A further complicating factor existed in the typical pathology lab because the sections were cut vertically, which meant that less than 1% of the entire tumor margin was actually examined microscopically. Taking wide excisions around the tumor in order to get all of it was too disfiguring. Clearly, another method of examining tissue was needed, and Dr. Mohs figured out a way to check 100% of the tumor margins - taking horizontal sections.
The new approach was described by Dr. Mohs:” The idea evolved of removing the tissue layer by layer and sectioning the entire undersurface (and sides) of each successive layer until a cancer-free plane was reached. This was the important concept that was the basis of all the developments that followed.” In the Mohs laboratory, frozen tissue sections taken from the horizontal plane, gave a more complete picture of the tumor’s bottom and sides. Only a few sections were needed to assess the entire tumor margin, versus the thousands that would have been needed with the vertical section technique.[/b][/size]
to be continued
“You can’t drive that car! It has no brakes.” Seventeen-year-old Freddie Mohs refused to heed his aunt’s caution. You see, “can’t” was not a word in his vocabulary even in 1927. And he had already figured out he could slow the car by downshifting the gears. That was Freddie all right. A little wild perhaps, but he grew up confident and what is more he trusted “his” own good judgment more than that of others. After all, “he “ was doing the driving.
He drove his high-school sweetheart on a 40-mile round-trip without mishap. When he was a bit older, he realized it had been a little foolhardy; nonetheless, the incident served to boost his self-confidence. His future bride, Mary Ellen Reynolds, trusted him and more important, believed in him. Freddie was imbued with strength of character and was not afraid of challenges that tested his principles. He went on to ignore objections and overcome all obstacles in developing a new form of surgery. Born amid controversy and skepticism, micrographic surgery was to revolutionize skin cancer treatment.
In the Beginning
Though many advances have come in the last 25 years, the development of what came to be Mohs surgery began in the mid 1930s, when Mohs, first as a medical student and the surgical resident, began to use the microscope to determine the margins of skin cancer. It took only two years to work out the microscopic technique, but more than 40 years passed before it was accepted by the medical establishment.
The first major step was taken when Dr.Mohs began experiments injecting various chemicals into rats to assess the response. He noted that the body’s immune cells were dense around normal issue but sparse around cancerous tissue. In addition, one of these chemicals, zinc chloride, preserved cellular details. This finding was the genesis of Mohs surgery. Dr. Mohs later pointed out that “this observation would ordinarily have gone unrecorded and unnoticed had it not initiated a train of thought that led to he concept of excising skin cancer under complete microscopic control.
Horizontal Sections Work Better
Dr. Mohs had many patients with large facial skin cancers that were difficult to treat. Before the Mohs technique was introduced, biopsies were frequently taken at random or specific intervals around the perimeter of the excision. This was unreliable because the in-between area escaped microscopic examination. A further complicating factor existed in the typical pathology lab because the sections were cut vertically, which meant that less than 1% of the entire tumor margin was actually examined microscopically. Taking wide excisions around the tumor in order to get all of it was too disfiguring. Clearly, another method of examining tissue was needed, and Dr. Mohs figured out a way to check 100% of the tumor margins - taking horizontal sections.
The new approach was described by Dr. Mohs:” The idea evolved of removing the tissue layer by layer and sectioning the entire undersurface (and sides) of each successive layer until a cancer-free plane was reached. This was the important concept that was the basis of all the developments that followed.” In the Mohs laboratory, frozen tissue sections taken from the horizontal plane, gave a more complete picture of the tumor’s bottom and sides. Only a few sections were needed to assess the entire tumor margin, versus the thousands that would have been needed with the vertical section technique.[/b][/size]
to be continued
平安夜
作者:luna_zjb 日期:2006-12-24
昨天今天在上海
作者:luna_zjb 日期:2006-12-23
昨天下了夜班就匆匆赶到了上海，本想住在徐家汇附近的，可是我付的起钱的饭店都客满了，所以还是住在了浦东世纪公园附近的一个homeinn，环境还是不错的，比我以前住过的一家super8要好太多。房间里面也很干净，该有的都有了，不该有的一样不见。就是床好像稍微硬了点，空调声音吵了些。
早上起来打车看到老感公司做的touchmedia的显示屏，不过是瞎的，老感还说十有八九都是瞎的，算是开了眼。上海的出租车非常干净，司机也非常友善，比杭州的感觉好太多。开会的地方在国际会展中心，里面的设施都有点老化了，到底还是时间长了。陆家嘴的高楼还是挺好看的，就是下面走的人，怎么看怎么不对劲。开会的时候碰到了南京的老师，心里蛮高兴的，一直对他们报有感激之情，当然，也有极个别的被我唾弃。会议的内容比我想像的要少些，看来皮肤外科的内容还是不算太丰富。主要是交叉太多而起步太晚，你能做的别人早已做的非常出色了。最后上来的一位老兄，展示了他非常出众的想像力和表演能力。我一直认为，医学的最终目的是给人看病的，你看不好病人，满足不了人们的需要，就是他妈的扯淡。一味的强调一些超前的概念，只能是一种姿态。毕竟，对于医学这种实践性的科学，一种概念的假设和这种概念最终被解决的本身比起来是明显缺乏力量的。
吃完中饭就回来了。到了家想想，自己才开始，还有很多要做的。
早上起来打车看到老感公司做的touchmedia的显示屏，不过是瞎的，老感还说十有八九都是瞎的，算是开了眼。上海的出租车非常干净，司机也非常友善，比杭州的感觉好太多。开会的地方在国际会展中心，里面的设施都有点老化了，到底还是时间长了。陆家嘴的高楼还是挺好看的，就是下面走的人，怎么看怎么不对劲。开会的时候碰到了南京的老师，心里蛮高兴的，一直对他们报有感激之情，当然，也有极个别的被我唾弃。会议的内容比我想像的要少些，看来皮肤外科的内容还是不算太丰富。主要是交叉太多而起步太晚，你能做的别人早已做的非常出色了。最后上来的一位老兄，展示了他非常出众的想像力和表演能力。我一直认为，医学的最终目的是给人看病的，你看不好病人，满足不了人们的需要，就是他妈的扯淡。一味的强调一些超前的概念，只能是一种姿态。毕竟，对于医学这种实践性的科学，一种概念的假设和这种概念最终被解决的本身比起来是明显缺乏力量的。
吃完中饭就回来了。到了家想想，自己才开始，还有很多要做的。
过了一小坎
作者:luna_zjb 日期:2006-12-19
前奏
作者:luna_zjb 日期:2006-12-17
TIME
作者:luna_zjb 日期:2006-12-16
Stand in front of the dark mirror
Looking for youself
Check the changing figure
If it''s your own arms
I mean if it''s your hands
He said he doesn''t dare to do so
The reason he offer is a little strange
Never stands on his own feet more
A procedure of solution
Merge into the other side
A kind of termination
Through the specular surface
Never standing on feet any longer
It''s time to put the yellow and red together
Looking for youself
Check the changing figure
If it''s your own arms
I mean if it''s your hands
He said he doesn''t dare to do so
The reason he offer is a little strange
Never stands on his own feet more
A procedure of solution
Merge into the other side
A kind of termination
Through the specular surface
Never standing on feet any longer
It''s time to put the yellow and red together
