2012/06/23星采診所院長楊志雄醫師。 星采／提供 ■王慰祖／撰稿■免動刀的「微整形」正夯，尤其是玻尿酸已進展到「微小分子」的劑型，有別於傳統玻尿酸訴求填補局部皮膚凹陷，這種娜莎玻尿酸微小分子劑型訴求增加皮膚保水度，以及促進膠原蛋白增生的效果，在熟齡市場頗受歡迎。星采診所院長楊志雄醫師指出，眼周是最容易洩漏年齡的部位，包括出現細紋、眼袋、淚溝、黑眼圈，主要在於眼周皮膚老化後，皮膚變薄、缺乏水份，動靜態細紋與皮膚凹陷就會跑出來，使得眼周皮膚暗沈或黑眼圈更加明顯。他表示，以往改善眼周細紋、淚溝，多半使用傳統玻尿酸或肉毒桿菌，但是這類玻尿酸分子較大，有些患者施打後，局部可以摸到有微細顆粒。至於肉毒桿菌素，有些人在意注射後臉部表情不自然。而注射這種微小分子玻尿酸可以改善靜態紋與部分動態紋，注射後看起來也比較自然。 楊志雄說，這種訴求微小分子劑型的玻尿酸，不同於傳統分子顆粒較大的玻尿酸劑型是做為填補凹陷之用，而是將局部皮膚「撐起來」，如同在局部做出蓄水池，使得飽水度增加，讓皮膚慢慢的拉提，變得更加緊緻。至於這種微小分子玻尿酸需要多久施打一次，才能維持最好的狀態。楊志雄表示，如果針對改善眼周細紋、淚溝，可以先嘗試一個療程，即一個月施打一次、連續三個月，每次施打1cc，約可維持一年左右的時間，但是因人而異，可以視個人狀況，建議半年至一年回診追蹤，針對局部適時加強效果，這種微整型在40至60歲的族群最受歡迎。談到目前玻尿酸微整形詢問度最高的項目，楊志雄說，除了應用在眼周之外，還可以用在臉頰、眼尾、眉毛拉提、改善法令紋以及頸部淺紋等部位的改善。而對於時有所聞有關微整型造成的醫療糾紛，要如何避免。楊志雄表示，經常發生微整形傳出的糾紛，例如注射後局部產生凹凸不平，或是笑起來出現一垞一垞，還有人眼袋看起來就像一條毛毛蟲，也有人注射後，局部皮膚出現藍黑色。他說，玻尿酸注射如果打的太淺就會出現有不平順的顆粒感或類似皮膚藍黑色澤但不是真的有瘀青的現象。打太深則容易傷到血管。所以，術前選擇施打者的技術、臨床經驗，例如下針處的位置與深淺以及注射的量，都取決於醫師的專業。還有就是醫師對於美學的專業度也很重要。此外，也有消費者認為玻尿酸微整型的價差很大，楊志雄表示，主要原因包括玻尿酸的產地、純度（與人體玻尿酸差異度小於1%），原廠玻尿酸在施打後也較不會產生過敏與發炎反應。 談到術後保養，楊志雄指出，施打玻尿酸可能有短暫1至2週的瘀青過程，術後保養應注重保濕與防曬，術後一周內也不要按摩，這些都是微整型療程後應注意的問題。
Sunday, June 24, 2012
心房顫動莫輕忽
2012/06/23台灣介入性心臟血管醫學會理事長程俊傑醫師。王慰祖／攝影 ■王慰祖／撰稿■雖然心房顫動是心律不整疾病中最常見的毛病，但卻嚴重被忽視。心房顫動患者若沒有給予有效的藥物治療，罹患中風的機率比一般人多上好幾倍，甚至嚴重的心房顫動有可能造成心衰竭而致死。台灣介入性心臟血管醫學會理事長、新光醫院內科部主任程俊傑醫師表示，心房顫動是最近一、兩年在國際間最受重視的議題，主要在於心房顫動較難及早發現，加上電燒術治療有限，三成的病患會再復發，這種心跳不規則的疾病如同「群魔亂舞」、不受控制，使得治療心房顫動對於心臟科醫師相當頭疼。至於心房顫動常見的症狀有哪些。程俊傑說，常見的症狀包括心悸（心跳快又亂）、頭暈、易喘等。臨床上經常發現，不少老年人喘的很嚴重，但卻搞不清楚為何會喘，有時候是因為心房顫動所引起。他強調，心房顫動因為心跳不規則，如果沒有給予有效的控制，時間一久，患者因為心房異常快速跳動，到最後跳到無力，造成心臟無法有效的收縮，血液出不去，就容易產生血栓，最常見的就是在腦部，這也是為何心房顫動患者最常發生腦中風的原因，以及其它全身性栓塞疾病。此外，長期心跳太快也可能導致心肌病變、心臟衰竭，甚至猝死症。程俊傑指出，根據臨床經驗，有心房顫動者，中風機率，是沒有心房顫動者的5倍之多。 至於要如何確定是心房顫動。程俊傑說，心房顫動可以藉由心電圖診斷出來，對於有些患者可能在門診檢查時心跳是正常的，還可以經由24小時心電圖確定。談到心房顫動的治療方法，程俊傑指出，因為心臟電燒術成效有限，三成的患者之後還會再復發，所以，治療上還是以藥物治療為主。但是以往治療心房顫動的藥物，很難讓心跳速度變慢，而且一旦阻止A處的問題，過陣子又會從B冒出來。他強調，最好的方式是「全面封鎖」，這也是目前國際間針對心房顫動最新的藥物治療策略。程俊傑指出，以往用來治療心房顫動的藥物如Amiodarone，它可以讓心跳慢下來，但是長期服用必須特別注意藥物的安全性，因為使用這種藥物容易造成甲狀腺異常、視力變模糊、肺部纖維化、肝功能異常等全身性副作用，如果選擇這種藥物，就得定期接受X光檢查，以及追蹤肝功能。新的藥物-Dronedarone不但可以讓異常心跳慢下來，還可以防止心房顫動，減少併發症的產生，如降低致死率與罹病率。還有因為它的安全性高，能夠減少中風的機率以及減少住院次數，患者使用約莫兩週，就可以看出治療效果。他建議有心房顫動問題者，平常應養成自我把脈的習慣，一旦出現不適症狀，應尋求心臟科或心律不整專科醫師確認，並且積極接受治療，才是面對心房顫動的正確觀念。
北部都會熟男大腸息肉好發族群
2012/06/23 ■王慰祖／撰稿■ 根據康聯預防醫學一份針對近1.2萬名北部地區健檢顧客進行的統計分析發現，男性篩檢有大腸息肉的發生率為25.61%，年齡集中在40歲以上，發現中年熟男是大腸息肉好發族群。康聯內視鏡室主任林姿伶醫師建議，一般民眾40歲以後，不論是利用國健局糞便潛血篩檢或是自費作大腸鏡，都應開始進行相關檢測，確保腸道健康。林姿伶表示，國人飲食攝取過多紅肉及缺乏運動，是大腸癌快速攀升的主因。國民健康局多年推動補助50至69歲民眾每2年1次定量免疫法糞便潛血檢查，就是希望能在徵狀發生前，揪出隱身在腸道內的早期癌化可能。她指出，康聯預防醫學至目前為止，共篩檢出15位受檢者罹患大腸直腸腫瘤，其中7位糞便潛血為陽性反應，也就是說，有超過5成以上必須搭配大腸鏡檢查，才能夠檢查出病變的可能，因為大腸直腸已有腫瘤病變者的糞便不一定會有潛血現象。林姿伶說，有些人以肉眼發現自己糞便帶血，常見的原因可能是痔瘡、肛裂或大腸炎，建議民眾還是要就醫檢查，因為還是有可能是腸息肉或腫瘤。她強調，一般常見的大腸直腸息肉為增生型息肉，外型多半扁平顏色蒼白，屬於良性，通常觀察或切除即可。但若是顏色鮮紅凸起的腺瘤性息肉，未來癌變的機會較大，建議要切除。從康聯近期篩檢的案例發現，即使受檢者癌胚抗原指數正常、糞便潛血為陰性，但在進行大腸鏡檢查時，仍發現有息肉或癌變的可能。根據今年2月新英格蘭醫學雜誌發表的一篇研究報告指出，小顆息肉的切除可以減少53%死於大腸癌的機會。因此，作大腸鏡檢查及切除腺瘤性息肉，如同做了大腸癌的「初段預防」，是屬於非常有價值的檢查及預防性醫療。康聯預防醫學院長陳皇光醫師表示，此次統計分析發現一些現象，以北部都會地區來說，男性大腸直腸息肉好發率高於女性。女性大腸直腸息肉發生率集中在50歲以上，男性發生率集中在40歲以上，50至69歲最為顯著。但是值得重視的是，20至39歲的年輕男性息肉發生率相對比女性高，印證除了大腸息肉病史或家族史、大腸癌家族史外，年齡大於50歲、喜吃過多的紅肉或過多燒烤肉類、蔬菜攝食過少、有高脂肪飲食習慣、體重超重，以及缺乏運動者、抽煙者等，都是容易好發大腸息肉的危險族群。陳皇光建議40歲以上的民眾要養成定期大腸篩檢的習慣，檢查的頻率可依照個人健康狀況或有無家族病史來進行，有大腸息肉、大腸炎症、腫瘤家族史或無任何症狀者，每2至3年作一次全大腸鏡篩檢即可，但若有家族病史者，建議應從家人確診為大腸癌的年齡，再提早10年開始進行腸鏡檢查。他強調，有腸胃症狀或糞便潛血反應為陽性者，應盡快接受全大腸鏡檢查。若有出現血便現象的年輕族群，考慮要安排大腸鏡檢查
工研院發表台灣首套3D錐形束斷層掃描儀技術
2012/06/23■王慰祖／撰稿■ 工研院日前發表一套低輻射劑量「3D錐形束（Cone Beam）X光斷層掃描儀技術」，這是第一部由國人自行設計的3D立體影像的X光斷層掃描儀，輻射劑量只有傳統X光片的三分之一，具有速度快、準確性高等優點，未來可應用在牙科及頭顱影像掃描，是牙科及頭部病症診斷的最佳利器。工研院電光所副所長刁國棟表示，台灣目前約有1萬6,000家牙科診所，一般治療多半是X光拍攝牙口影像，或是人工植牙治療上採用國外購買的昂貴3D「錐形束」X光斷層掃描儀，取得3D牙口相片。這兩類醫療器材因取得影像面積小，需要重覆掃描或拍攝，取得充足的診斷醫療影像，患者曝露在輻射下。工研院以3D影像豐富的技術經驗，整合立體掃描取像系統、X光光源、伺服馬達機電系統及平板X-ray感應器等系統，自主開發出「3D錐形束X光斷層掃描儀」，可快速提供大面積3D影像，滿足治療上的需求，不僅為牙科治療提供更精準醫療參考，也為患者提供更安全的醫療技術。這項技術是工研院首次發表，目前正在徵求技轉廠商進行合作，期待透過與業界合作，為台灣高階醫療器材貢獻發展新機會。刁國棟說，以往X光斷層掃描多採用扇條形方式進行180度掃描，由於採用光束模式建置影像，掃描區域小，必須長時間掃描才能取得影像，取相快門也需長時間打開，讓患者重複曝露在X光下。工研院開發的「3D錐形束斷層掃描儀」，整合市場上的錐形束X光源及平板螢幕感應器，配合3D重建、影像補償軟體系統及機電整合技術，運用大面積的錐形束X光在270度內進行掃描，在1.5分鐘內即可快速取得90張3D影像後，再輔以3D軟體即能重建完整的患者病灶的3D圖。由於錐形束X光取像區域大，快門可以關閉，只需在拍攝時打開，讓X光輻射量較傳統大幅減少三分之一。此外，由於採用智慧型影像校正方法，在進行掃描同時，同步進行取像與進行拍攝校正，不僅降低因震動造成的取像模糊困擾，也提升拍攝的精準度。3D錐形束斷層掃描儀不僅可應用在牙科、腦科等疾病診斷，其基礎技術也可運用於設計下世代高對比乳房攝影系統，對癌細胞軟組織做更準確辨識與診斷，期能大幅改善檢測正確率從3成提升至5成以上。
'Trust' hormone oxytocin found at heart of rare genetic disorder
June 22, 2012 in Neuroscience The hormone oxytocin - often referred to as the "trust" hormone or "love hormone" for its role in stimulating emotional responses - plays an important role in Williams syndrome (WS), according to a study published June 12, 2012, in PLoS One. How I overcame Autism? - Sharing my First Hand Experience And Hypothesis - iamvine.com The study, a collaboration between scientists at the Salk Institute for Biological Studies and the University of Utah, found that people with WS flushed with the hormones oxytocin and arginine vasopressin (AVP) when exposed to emotional triggers. The findings may help in understanding human emotional and behavioral systems and lead to new treatments for devastating illnesses such as WS, post-traumatic stress disorder, anxiety and possibly even autism. "Williams syndrome results from a very clear genetic deletion, allowing us to explore the genetic and neuronal basis of social behavior," says Ursula Bellugi, the director of Salk's Laboratory for Cognitive Neuroscience and a co-author on the paper. "This study provides us with crucial information about genes and brain regions involved in the control of oxytocin and vasopressin, hormones that may play important roles in other disorders." WS arises from a faulty recombination event during the development of sperm or egg cells. As a result, virtually everyone with WS has exactly the same set of genes missing (25 to 28 genes are missing from one of two copies of chromosome 7). There also are rare cases of individuals who retain one or more genes that most people with the disorder have lost. To children with WS, people are much more comprehensible than inanimate objects. Despite myriad health problems they are extremely gregarious, irresistibly drawn to strangers, and insist on making eye contact. They have an affinity for music. But they also experience heightened anxiety, have an average IQ of 60, experience severe spatial-visual problems, and suffer from cardiovascular and other health issues. Despite their desire to befriend people, they have difficulty creating and maintaining social relationships, something that is not at all understood but can afflict many people without WS. In the new study, led by Dr. Julie R. Korenberg, a University of Utah professor and Salk adjunct professor, the scientists conducted a trial with 21 participants, 13 who have WS and a control group of eight people without the disorder. The participants were evaluated at the Cedars-Sinai Medical Center in Los Angeles. Because music is a known strong emotional stimulus, the researchers asked participants to listen to music. Before the music was played, the participants' blood was drawn to determine a baseline level for oxytocin, and those with WS had three times as much of the hormone as those without the syndrome. Blood also was drawn at regular intervals while the music played and was analyzed afterward to check for real-time, rapid changes in the levels of oxytocin and AVP. Other studies have examined how oxytocin affects emotion when artificially introduced into people, such as through nasal sprays, but this is one of the first significant studies to measure naturally occurring changes in oxytocin levels in rapid, real time as people undergo an emotional response. There was little outward response to the music, but when the blood samples were analyzed, the researchers were happily surprised. The analyses showed that the oxytocin levels, and to a lesser degree AVP, had not only increased but begun to bounce among WS participants while among those without WS, both the oxytocin and AVP levels remained largely unchanged as they listened to music. Korenberg believes the blood analyses strongly indicate that oxytocin and AVP are not regulated correctly in people with WS, and that the behavioral characteristics unique to people with WS are related to this problem. "This shows that oxytocin quite likely is very involved in emotional response," Korenberg says. To ensure accuracy of results, those taking the test also were asked to place their hands in 60-degree Fahrenheit water to test for negative stress, and the same results were produced as when they listened to music. Those with WS experienced an increase in oxytocin and AVP, while those without the syndrome did not. In addition to listening to music, study participants already had taken three social behavior tests that evaluate willingness to approach and speak to strangers, emotional states, and various areas of adaptive and problem behavior. Those test results suggest that increased levels of oxytocin are linked to both increased desire to seek social interaction and decreased ability to process social cues, a double-edged message that may be very useful at times, for example, during courtship, but damaging at others, as in WS. "The association between abnormal levels of oxytocin and AVP and altered social behaviors found in people with Williams Syndrome points to surprising, entirely unsuspected deleted genes involved in regulation of these hormones and human sociability," Korenberg said. "It also suggests that the simple characterization of oxytocin as 'the love hormone' may be an overreach. The data paint a far more complicated picture." In particular, the study results indicate that the missing genes affect the release of oxytocin and AVP through the hypothalamus and the pituitary gland. About the size of a pearl, the hypothalamus is located just above the brain stem and produces hormones that control body temperature, hunger, mood, sex drive, sleep, hunger and thirst, and the release of hormones from many glands, including the pituitary. The pituitary gland, about the size of a pea, controls many other glands responsible for hormone secretion. Overall, the researchers say, their findings paint a very hopeful picture, and the study holds promise for speeding progress in treating WS, and perhaps Autism and anxiety through regulation of these key players in human brain and emotion, oxytocin and vasopressin. Journal reference: PLoS ONE
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