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*核醫報導 
* 氫 
放射核種的化學量(chemical quantities)都非常小。因此,放射藥物不會干擾它所要偵測的正常生化反應,它的功能就像是一個示蹤劑(tracer),不同於X光檢查用的顯影劑,它並不會產生過敏反應。例如,甲狀腺攝取檢查所使用的碘含量僅祇是吃一餐飯所使用的食鹽內的碘含量的數千分之一。各種放射藥物可應用於不同器官的檢查,如下表: 
 



















































































造影檢查放射藥物作用機轉
肺造影鎝-99m白蛋白大凝聚粒(albumin Macroaggregates)或小球(microspheres)微血管阻斷,測定肺血流 灌注,診斷肺栓塞。
骨骼造影鎝-99m磷酸鹽(phosphonates)吸著於骨骼上,診斷骨 轉移癌,發炎等病。
甲狀腺、唾液腺、 Meckel氏憩室造影鎝-99m過鎝酸鹽(pertechnetate)離子的主動運輸,診斷甲 狀腺疾病,唾腺功能評估,偵測憩室內胃黏膜。
肝、脾、及骨髓造影鎝-99m硫膠溶體(sulfur colloid)經由網狀內皮系統攝取, 診斷肝、脾病灶及骨髓分布。
肝細胞及膽道造影鎝-99m IDA(labeled IDA)衍生物肝細胞主動運輸及排除, 測定肝功能及膽流,診斷急性膽囊炎及阻塞性黃疸。
心肌血流灌注及肌肉造影鉈-201,鎝-99m M1B1(isonitriles)或標幟之脂肪酸經由Na+-K+-ATPase酵 素作用之主動運輸,診斷 冠心疾及肌肉缺血。
腫瘤造影鎵-67枸椽酸(Ga- 67 acitrate)腫瘤攝取的作用機轉仍不清楚。可能的機轉是: 鎵-67與腫瘤細胞膜上的 運鐵蛋白元(transferrin-specific)受體作用後進入細胞,再與細胞 內的溶解體(lysozomes)結合。鎵-67可反塵細胞 的代謝活性。
銦-111,碘-131,鎝-99m單株抗體經由免疫的作用機轉進入腫瘤細胞,可作各類癌 病之診斷、療效評估及追蹤。
感染或發炎過程的造影鎵-67枸椽酸(citrate)作用機轉仍不清楚。可能 的機轉是:鎵-67可與白 血球,細菌殘骸及乳酸鐵 蛋白元(lactoferrin)作用,診斷發炎病灶。
銦-111白血球(In- 111 leukocytes)白血球會在發炎的病灶處聚集。
腦造影碘-123 IMP(I-123 iodoampheetamine)鎝-99m HMPAO為一脂溶性物質,可通過腦血管 屏障進入腦部,診斷腦中 風,癡呆症,偵測癲癇病灶。
鎝-99m GH(glucoheptonate),鎝-99m DTPA(DTPA)在正常情況下不會進入腦組織,只有在腦血管屏 障被破壞時(如腫瘤,膿 瘍,血腫,梗塞)才進入不正常的組織內。
腎臟造影及腎功能評估鎝-99m DTPA腎絲球過濾及排泄,評估腎功能。
鎝-99m DMSA皮質細胞攝取,診斷腎病灶,評估腎功能。
碘-131馬尿酸(hippuran)腎小管細胞攝取及分泌,診斷腎功能。
甲狀腺攝取功能及造影碘-123(I-123),碘-131(I-131)甲狀腺吸收碘合成甲狀腺荷爾蒙。可行甲狀腺功 能評估,甲狀腺病灶偵測 及甲狀腺癌術後追蹤。碘 -131亦可用於轉移性甲 狀腺癌之治療。

核子醫學最常用的二種放射核種是鎝-99m及碘-131。約80%的核子醫學放射藥物是標記鎝-99m的化合物,標記碘-123及碘-131的化合物約偵核子醫學放射藥物的15%,其他放射核種大約只佔5%。臨床上喜歡用鎝-99m的化合物來造影的原因是因鎝-99m的物理及伽傌射線特性很適合造影。它的物理半衰期是6小時,所以病人不會接受過多的輻射;而且它放射出的140keV的光子也很適宜造影。正子放射性(positron-emitting)同位素氧-15,氮-13及碳-11可標幟到各種生理示蹤劑,如氧,二氧化碳,一氧化碳等。標記的氣體如與血紅素結合可用以測量血流及血量。碳水化合物,氨基酸,及脂肪酸均可用碳-11來標幟。氮-13標幟的氨也可用來測量血流。因為氧-15的半衰期僅為2分鐘,氮-13是10分鐘,碳-11是20分鐘,故須要一個迴旋加速器就近生產這些同位素。氟-18也是一個正子放射性同位素,它可用來標幟去氧葡萄糖(deoxyglucose)及其它有用的物質。但因它的半衰期較長(110分鐘),故可在其它地方經由迴旋加速器生產氟-18,再將它運到醫院的核子醫學部門做這項檢查。


放射藥物可用來做功能性的檢查,也就是說一個疾病在身體上造成功能性的變化時(但尚未引起結構的改變)即可被偵測出來。在臨床上這種功能性的檢查是一個非常重要的診斷工具。放射藥物另外的一個特點是它可用定量的方法來測量身體各種器官功能的變化情形。核醫藥物在診斷用途方面,因為用量極少,病患所受的輻射量小,均在可接受範圍內,不會產生任何傷害。治療用核醫藥物,必須有足夠的輻射量,殺死癌細胞,所以病患所受的腫瘤局部輻射量較大,但全身輻射劑量不會太高,為了治病,仍然可以接受。


表二、核能研究所已獲藥品許可證之核醫藥物產品
























































名稱


功能


備考

核研碘-131口服液 (R-000007)甲狀腺功能及病變之診斷與治療反應器產品藥物
高比活性鎝-99m注射液(R-000006)各種器官疾病造影反應器產品藥物。
核研琥珀鎝腫瘤造影劑(R-000010)甲狀腺髓質腫瘤之造影檢查反應器產品藥物,提供技術服務。
核研所宏寶鎝腦造影劑(R-000011)中風、癲癇、暫時性腦部缺血及腦腫瘤等腦部病變之造影檢查反應器產品藥物,提供技術服務。
核研氯化亞鉈(鉈-201)(R-000012)心臟及腫瘤病變之造影檢查加速器產品藥物,提供技術服務。
核研甲基雙磷酸骨骼造影劑(R-000013)骨骼病變造影診斷反應器產品藥物,提供技術服務。
核研碘化鈉(碘-123)口服液甲狀腺功能及病變之造影檢查加速器產品藥物,申請藥品許可證中。
核研碳-13驗菌劑胃腸幽門螺旋桿菌感染病變之檢驗穩定同位素藥物,申請藥品許可證中。
核研檸檬酸鎵(Ga-67)腫瘤造影劑發炎與腫瘤造影診斷加速器產品藥物,申請藥品許可證中。

註:附表由前核能研究所丁副所長幹提供,特此致謝!



 
















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床上CT、MRI、PET三種檢查的比較




添加時間:2014-12-3









CT(X線電子計算機斷層掃描)主要是利用X線斷層掃描,電光子探測器接收,並把信號轉化為數字輸入電子計算機,再由計算機轉化為圖像,是一種無痛苦、無損傷的輔助檢查工具。
CT的特點:具有檢查方便、安全、無痛苦、無創傷的特點。圖像清晰、分辯力高、解剖關係明確、病態顯影清楚。
與MRI比較起來,CT的優點主要在於對骨性疾病、早期腦出血的顯示優於MRI,同時成像速度快,器官的運動偽影較小,CT的優勢還在對肺部、肝髒的檢查 ,MRI(磁共振)主要看軟組織病變,看腦質的問題,無論是看腫瘤性病變還是血管性病變,核磁共振的效果均遠好於CT。但CT在看顱骨和鈣化性病灶方麵優於核磁共振。CT價格低廉,對人體有一點危害。
磁共振成像(MRI)是根據有磁距的原子核在磁場作用下,能產生能級間的躍遷的原理而采用的一項新檢查技術,對人體無害。MRI檢查安全。MRI對腦內低度星形膠質細胞瘤、神經節、神經膠質瘤、動靜脈畸形和血腫等的診斷確認率極高。MRI能清楚地顯示癲癇患者的腦萎縮,對腦實質和腦脊液的顯示度極好。
MRI與CT比較,其主要優點是:

離子化放射對腦組織無放射性損害,也無生物學損害。
可以直接做出橫斷麵、矢狀麵、冠狀麵和各種斜麵的體層圖像
沒有CT圖像中那種射線硬化等偽影。
不受骨像幹擾,對後顱凹底和腦幹等處的小病變能滿意顯示,對顱骨頂部和矢狀竇旁、外側裂結構和廣泛轉移的腫瘤有很高的診斷價值
顯示疾病的病理過程較CT更廣泛,結構更清楚。能發現CT顯示完全正常的等密度病灶,特別能發現脫髓鞘性疾病、腦炎、感染性脫髓鞘、缺血性病變及低度膠質瘤。
對神經、血管、肌肉等軟組織成分顯示明顯優於CT。
其主要缺點為:

1.和CT一樣,MRI也是影像診斷,很多病變單憑MRI仍難以確診,不像內窺鏡可同時獲得影像和病理兩方麵的診斷;
2.對肺部的檢查不優於X線或CT檢查,對肝髒、胰腺、腎上腺、前列腺的檢查不比CT優越,但費用要高昂得多;
3.對胃腸道的病變不如內窺鏡檢查;
4.體內留有金屬物品者不宜接受MRI。
5. 危重病人、妊娠3個月之內的、帶有心髒起搏器及鋼板的患者不能做MRI。
正電子發射斷層攝影(PET)是新發展起來的核醫學檢查方法。掃描前先給病人注射一種標記某種正電子的放射性製劑,從它們所參與的代謝過程來測定腦組織的代謝改變。由於大腦所需能量的80%來自葡萄糖,大腦某一部位的功能越活躍,那個部位的腦細胞和葡萄糖代謝就越旺盛。PET可根據葡萄糖代謝率的高低,來檢測腦異常代謝的確切部位。PET可在三維空間測定出癲癇病人腦代謝和血流局限異常 。癲癇病人腦病灶區在發作時常有代謝增強,發作間隙期病灶區顯示代謝降低,從而有助於確定病灶。是目前惟一可在活體上顯示生物分子代謝、受體及神經介質活動的新型影像技術,現已廣泛用於多種疾病的診斷與鑒別診斷、病情判斷、療效評價、髒器功能研究和新藥開發等方麵。 與前三者的成像原理有本質的區別。
PET 相較於CT和MRI來說,其主要特點為:


1.靈敏度高。PET是一種反映分子代謝的顯像,當疾病早期處於分子水平變化階段,病變區的形態結構尚未呈現異常,MRI、CT檢查還不能明確診斷時,PET檢查即可發現病灶所在,並可獲得三維影像,還能進行定量分析,達到早期診斷,這是目前其它影像檢查所無法比擬的。
2.特異性高。MRI、CT檢查發現髒器有腫瘤時,是良性還是惡性很難做出判斷,但PET檢查可以根據惡性腫瘤高代謝的特點而做出診斷。
3.全身顯像。PET一次性全身顯像檢查便可獲得全身各個區域的圖像。
4.安全性好。PET檢查需要的核素有一定的放射性,但所用核素量很少,而且半衰期很短(短的在12分鍾左右,長的在120分鍾左右),經過物理衰減和生物代謝兩方麵作用,在受檢者體內存留時間很短。一次PET全身檢查的放射線照射劑量遠遠小於一個部位的常規CT檢查,因而安全可靠.




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精品活动:第四届全国八年制医学生论坛官方通讯
 
 
2014-05-15     作者:论坛筹委会新闻组 编辑:刘萌      来源:投稿       浏览次数:2490
 

    湘雅医学院自1914年成立以来,饱经风雨与荣耀,即将走过她光辉的第100年。时值百年院庆之际,湘雅学子出谋划策,力求打造一个不同凡响的百年。其中由湘雅长学制莘莘学子全权负责的第四届全国八年制医学生论坛,作为湘雅百年院庆唯一一项学生性质的学术活动,将为百年院庆打响意义非凡的一炮。


    第四届全国八年制医学生论坛将于2014年7月17日在中南大学湘雅医学院隆重举办。本届论坛主题为“ communication、cooperation、cultivation”,即交流、合作、培养,简称“3C论坛”,而这也正是湘雅百年树人的核心理念。


    在为期五天的论坛活动中,将有来自北京协和医学院、北京大学医学部、华中科技大学同济医学院、浙江大学医学院、中山大学医学院、复旦大学上海医学院、上海交通大学医学院、四川大学华西医学院、南方医科大学、第二军医大学、第三军医大学、第四军医大学、中南大学湘雅医学院(学校名称随机排列,不分先后)等13所全国高等院校的代表共聚一堂,就“卓越医师培养”,“医学伦理道德”,“医学生就业”,以及“Project+Fair”等四个议题内容进行讨论。


    其中,卓越医师培养议题组旨在深入探讨八年制学子的培养方向,重点讨论如何协调出国交流和毕业之间的矛盾,并希望通过模拟教学及临床技能培训等方式展现湘雅医学院临床教学水平,并与其他院校相互借鉴经验,共同成长,共同进步;Project Fair议题组旨在传递医学生正能量,在医患关系日益紧张,而医学生的学业、就业压力不断增大的今天,希望借爱心病房等社会实践的活动形式与内容,以及医学场景情景剧的排练等议题内容,传播医学生心中的阳光与温暖;医学伦理道德议题组重点就器官移植这一话题进行讨论,将举行专题讲座,带领同学们参观湘雅三医院移植科、捐献办,并以随机参访路人的方式广泛收集大众意见,进行对比分析,通过这些途径,了解器官移植方面的伦理道德,增强大家的认知;医学生就业与发展类议题组重点关注在就业压力如此大的今天,即将毕业的医学生们该何去何从,并希望通过问卷调查、模拟面试、情景剧等方式了解大家对就业的想法,彼此交流意见,以提高自身的竞争力,在大批毕业生中崭露头角。同时在与会的五天内,中南大学湘雅医学院长学制将派出五十余名志愿者参与协助各个议题组完成任务。


    全国八年制医学生论坛在此前轮经三届,分别在北京大学医学院、四川大学华西医学院和南方医科大学举办。


    为抛砖引玉,现送上本届论坛所涉及的3个LOGO,其图案及代表含义如下所示。


1、湘雅医学院百年华诞官方LOGO。


 


 


金門美兆診所 慶生診所13所全国高等院校[2017八年制醫學            


                                              


    图1展示的是“圆”与中国红的巧妙运用,“湘雅醫學院”的厚重书法与英文的结合,加之下方“1914-2014”的点明,寓意湘雅百年壮阔的辉煌历史与现代传承。气势恢宏的湘雅大楼上空,飘带舞动成数字“100”,直上云霄,象征今天的湘雅人,昂首迈向新纪元,献礼百年湘雅!


2、论坛LOGO(1)。


金門美兆診所 慶生診所13所全国高等院校[2017八年制醫學


 


 


    第二个LOGO如图所示,色彩缤纷,意义非凡。首先黄色和绿色交相辉映,组成了湘雅的缩写“xy”。再加上蓝色的点缀,组成了纵向的“100”和横向的“8”,象征着八年学子预祝湘雅百年华诞。同时最上面有五颜六色的烟花绽放,代表着长沙特色的橘子洲头烟花燃放,也寓意着湘雅百年历史如烟花般璀璨。下面隐约可见的房子轮廓,代表了老湘雅特色红楼。最下面的一行字点出了百年院庆的一大亮点——“第四届八年制医学生论坛”,而承办院校即为湘雅医学院。


 


3、论坛LOGO(2)


 


金門美兆診所 慶生診所13所全国高等院校[2017八年制醫學


 


 


     整个logo以蓝色为基调,代表了医学生的沉着冷静。图中的房子为湘雅特色的红楼,周围伴以和平象


征的橄榄枝,最外围凸显了3C理念。彼此融为一体,相得益彰。


    悠悠百年,是历史的百年,也是湘雅医学院的百年。愿湘雅百年的峥嵘历史能指明我们前行的道路,收获百年之后更大的辉煌!



 

















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杜家毫[
 































































杜家毫
 
中國共產黨 中國共產黨湖南省委員會書記

現任

就任日期
2016年8月28日
前任徐守盛
湖南省人民政府省長
任期
2013年5月31日-2016年9月5日
前任徐守盛
繼任許達哲
個人資料
出生1955年7月(61歲)
上海市
籍貫浙江鄞縣
政黨中國共產黨 中國共產黨
居住地湖南省長沙市
母校華東師範大學
職業官員

杜家毫(1955年7月),祖籍浙江鄞縣,生於上海。男,漢族。1973年3月參加工作,1973年12月加入中國共產黨。華東師範大學中文專業畢業,中央黨校研究生文化,高級工商管理碩士,高級經濟師,高級政工師。中共第十五大、十六大、十七大代表,第十八屆中央委員會候補委員。現任中共湖南省委書記、省人大常委會主任。


 



 


簡歷[編輯]


上海[編輯]


1973年3月,供職於上海躍進農場,任工人、副指導員、黨支部副書記。1975年7月,任上海躍進農場黨委委員、綜合計劃組組長、場黨委副書記、場政治處副主任。1978年9月,任上海市農場局團委副書記、書記(其間:1981年9月—1982年1月在中央團校第20期培訓班學習;1982年9月—1983年1月在上海市委黨校第九期輪訓班學習)。1984年6月,任上海市農場局科技處負責人。1985年6月,任上海市農場局工會副主席(1987年2月明確為正處級,並主持工作)(其間:1983年9月—1988年6月在華東師範大學夜大」中文專業學習,獲文學學士學位)。1990年4月,任上海市農場局黨委委員、黨政辦公室主任。1992年3月,任中共上海市松江縣委副書記。1993年1月,任中共松江縣委書記(其間:1995年9月至1996年7月在中央黨校第11期中青年幹部培訓班學習;1995年9月在中央黨校在職研究生班世界經濟專業學習)。1998年7月,任中共松江區委書記。1998年10月,任中共楊浦區委書記。2003年2月,任中共上海市委副秘書長、上海市人民政府黨組成員、副秘書長。2003年4月,任中共上海市委副秘書長、上海市人民政府秘書長、市政府黨組成員、辦公廳主任。2004年4月,任中共上海市委常委、浦東新區區委書記(其間:2005年3月—2007年5月在中歐國際工商學院工商管理碩士學位課程班學習)。


黑龍江[編輯]


2007年12月,任中共黑龍江省委常委、黑龍江省人民政府常務副省長[1]。2011年4月,任中共黑龍江省委副書記[2][3]。2011年9月,卸任黑龍江省人民政府常務副省長職務。2012年11月,當選第十八屆中共中央候補委員


湖南[編輯]


2013年3月,任中共湖南省委副書記[4]。4月10日,任湖南省人民政府副省長,提名為湖南省人民政府代理省長,並於5月31日正式當選[5]。2013年5月27日,被湖南省第十二屆人大常委會第二次會議補選為第十二屆全國人民代表大會代表[6]。2016年8月,任中共湖南省委書記[7]。2017年1月,當選湖南省人大常委會主任。


褒獎榮譽[編輯]



參考文獻[編輯]



外部連結[編輯]



 
















































中國共產黨職務
前任:
徐守盛
中國共產黨湖南省委員會書記
2016年8月-
現任
前任:
黃建盛
中國共產黨黑龍江省委員會政法委員會書記
2012年5月-2013年3月
繼任:
郝會龍
前任:
杜宇新
中國共產黨黑龍江省委員會專職副書記
2011年4月-2013年3月
繼任:
陳潤兒
前任:
姜斯憲
中國共產黨上海市浦東新區委員會書記
2004年5月-2007年12月
繼任:
徐 麟
中華人民共和國國徽 中華人民共和國地方各級人民代表大會
前任:
徐守盛
湖南省人民代表大會常務委員會主任
2017年1月-
現任
中華人民共和國 中華人民共和國政府職務
前任:
徐守盛
湖南省人民政府省長
2013年5月-2016年9月
繼任:
許達哲
前任:
栗戰書
黑龍江省人民政府常務副省長
2007年12月-2011年9月
繼任:
劉國中





























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子宮肌瘤免動刀新療法-海扶刀(HIFU)


婦科主任   鄭丞傑 教授(104年8月)




子宮肌瘤是子宮最常見的腫瘤,據估計35歲以上的婦女,至少五分之一長有或大或小的肌瘤,40歲以上的婦女,五分之二以上的人有子宮肌瘤,其中不少人根本沒有症狀,且肌瘤是良性,不大又沒症狀者根本不必大驚小怪,緊張兮兮。


形成子宮肌瘤的原因至今未明,不過可能和動情激素有關,因為絕大部份的肌瘤發生於育齡婦女,且停經後肌瘤大都會逐漸變小。但是不是因為體內女性荷爾蒙太多才造成子宮肌瘤?並非如此!長子宮肌瘤的婦女動情激素和一般人一樣,可能是她的子宮之動情激素接受體較多,或者接受體對動情激素之刺激較敏感所致。總之,可以說和體質有關;當然,可能也有家族傾向,媽媽女兒、姊姊妹妹常常「同病相憐」。


症狀


子宮肌瘤如向外長,稱為「漿膜下型」,通常不會引起出血症狀,大到相當程度會引起壓迫症狀。最常見的是長在肌肉層中,稱為「肌肉內型」,長向子宮內膜,亦即子宮腔的則為「黏膜下型」,兩種都會引起經量多、經期長,後者且會造成不孕或習慣性流產。


大致而言,子宮肌瘤造成的主要症狀是出血,有些則有下墜感、腹脹感,如向前壓迫到膀胱,則會頻尿或排尿困難,向後壓迫到直腸,則會便秘或排便疼痛。長期月經量太多或經期拖太長,會造成貧血、倦怠感、頭痛、呼吸困難等。


另外,究竟臨床上認為是子宮肌瘤,手術切下來發現是肌肉癌的機率有多高?筆者曾經統計過七千八百七十八個以子宮肌瘤切除術、子宮全切除術、子宮次全切除術(保留子宮頸)開刀切下來的「子宮肌瘤」,結果病理檢查,其中有十六個為惡性的子宮平滑肌肉癌(LMS)、子宮內膜間質肉癌(ESS)、惡性彌勒氏管混合肉癌(MMMT),因此惡性的機率和國外文獻的報告一樣,為千分之二、三之間。不過值得一提的是,這些惡性肉瘤(Uterine Sarcoma) 即使手術切除,加上放療、化療,預後也大多不太好,死亡率常常超過一半以上,這是必須小心的一點。不久之前去世的美食作家韓良露,便是經診斷出惡性肉瘤,手術到死亡,不到一個月。


手術治療


通常如果有下列情形者為手術適應症:


◎有明顯的不適症狀,例如月經量太大、月經期太長、貧血、頻尿等。


◎在追蹤檢查中日益快速變大。


◎停經後反而更顯著變大。


◎長期不孕且無其他因素存在。


有上述症狀才需開刀,否則不必平白挨一刀,尤其是小於五公分的肌瘤,絕大多數是沒有症狀,不需動刀的。而手術時究竟只拿掉瘤,還是摘除整個子宮,需視肌瘤大小、位置、數目以及患者的年齡和生育狀況,做通盤考量,才能適當決定。


金門美兆診所''朝鮮幹細胞 海扶刀 MRI HYPERTH


 


藥物治療


有一些中醫、中藥商宣稱有中藥可以使瘤縮小,但是到目前為止,還沒有經過科學化研究證實有效且不會復發的藥方。臨床上在門診所見,時常是已經大到七、八公分以上的腫瘤,子宮已經比拳頭還大,而且又月經量過多,嚴重貧血的中年婦女,由於害怕失去子宮,而四處亂吃中藥、草藥,過了幾個月再照超音波,發現腫瘤更大了,才死心接受手術。有些則是腫瘤似乎小了一些,但停藥就又很快地恢復原狀了。


其實現代醫學中,倒是有一種真的可以使子宮肌瘤變小的藥,那就是名為「腦下垂體激素促進素」(GnRH)的荷爾蒙製劑,商品名為Leuplin, Buserelin, Zoladex等,這種藥目前用於不孕症的治療中,它造成類似停經期的狀態,因此子宮肌瘤會縮小,問題是它既造成更年期的不適症狀,而且一旦停藥,肌瘤又恢復原來的大小,因此目前醫界並不建議用於治療子宮肌瘤,健保也不給付。不過有些醫師用於讓巨大的子宮肌瘤縮小些,然後再進行手術,可使手術的皮膚切口不必太大。


海扶刀(HIFU)療法


2015年,台灣引進了免動刀的新療法-海扶刀,這是一種使用超音波穿過肚皮,將高熱能照在子宮肌瘤上的熱熔法。 海扶刀又叫超音波聚焦刀,是(「高強度聚焦超音波腫瘤治療系統(High-intensity focused ultrasound)」的譯稱,英文縮寫為「HIFU」,也被稱為聚焦超音波手術(FUS:Focused Ultrasound Surgery)。這是一種不需要切開皮膚,不需要穿刺就可以殺滅體內腫瘤的新技術,也有人稱之為「無創手術」。


超音波消融治療子宮肌瘤,是一種新的非侵入性(免開刀、不流血)治療子宮肌瘤的無創治療方式。治療原理和聚焦太陽光相似, 藉由從體外將超音波聚焦在體內子宮肌瘤處,使焦點區域產生高溫,讓子宮肌瘤組織壞死,達到無創消融子宮肌瘤的目的。


治療過程不損傷正常的子宮組織, 消融治療所產生的壞死組織可被正常組織逐漸吸收,使子宮肌瘤變小,達到減輕或緩解相應症狀。


超音波消融絕大部分是一次治療即可完成,治療的有效率在95%左右。判斷標準主要以症狀緩解,影像學檢查(磁振掃描和超音波掃描)判斷子宮肌瘤的供血情況,肌瘤吸收程度等幾方面綜合考慮。當然超音波療法也存在5%失敗的情況,但即使治療效果不佳,對身體的傷害也很微小,部分還可以再次超音波消融,亦不會影響後續使用其他治療方式。


高醫大附設中和紀念醫院從2015年4月起啟用南臺灣第一台海扶刀,健保不給付,收費16-18萬左右,和達文西機械手臂手術收費相差不多,但由於肚皮沒傷口,又不必麻醉,預期將會吸引愛美的女性選擇這種新療法。


 


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Bio-oxidative medicine is the addition of oxygen directly to the tissues of the body in the form of singlet oxygen (lone oxygen atoms) in a highly reactive state. To more fully understand the chemistry involved, review: Bio-oxidative Medicine.
In living systems oxygen (as O2) is transported by hemoglobin, a protein found in red blood cells. This is a highly efficient way of conducting oxygen from the lungs to the tissues of the body and insuring it does not react with anything along the way. Because it is bound by hemoglobin, it is unable to react to anything else until it is released by the hemoglobin (which then picks up carbon dioxide and transports it to the lungs).
In bio-oxidative medicine, oxygen is introduced directly into the body as hydrogen peroxide (H2O2) or as ozone (O3). Although ozone is used safely and with great benefit throughout Europe and in many other parts of the world, the medical establishment in the United States refuses to recognize it as a valid therapy and actively persecutes doctors who use it. Luckily, hydrogen peroxide is not treated in this way, even though it is an equally powerful oxidative approach.
The chemical reaction looks like this:
H2O2 → H2O + O-
This is chemical shorthand to indicate that in the body, hydrogen peroxide is converted to water and singlet oxygen. This singlet oxygen located at the end of this reaction is a powerful oxidizing agent. It is the active agent in hydrogen peroxide therapy.
In IV H2O2 therapy, hydrogen peroxide is infused into the circulatory system through a vein in the arm. It drips in over a ninety-minute period. Five cc of pharmaceutical-grade, three-percent hydrogen peroxide are put in 500 cc five percent glucose in water as a carrier solution. Two grams of magnesium chloride are added alon gwith a small amount of manganese to prevent vein sclerosis.
In the blood, it encounters two enzymes: catalase and cytochrome-C. Catalase drives the above reaction to completion immediately. That part of the hydrogen peroxide that binds with cytochrome-C, however, is not allowed to become water and singlet oxygen for a period of forty minutes. After forty minutes of being bound to cytochrome-C this enzyme begins to act like catalase and breaks down the hydrogen peroxide to water and singlet oxygen. By this time, the hydrogen peroxide/cytochrome-C complex has been spread throughout the body. In this way the benefits of hydrogen peroxide are made available to all cells.
The effect of singlet oxygen in the human body is twofold. It kills, or severely inhibits the growth of, anaerobic organisms (bacteria and viruses that use carbon dioxide for fuel and leave oxygen as a by-product). This action is immediate, on contact with the anaerobic organism. Anaerobic bacteria are pathogens, the organisms which cause disease. All viruses are anaerobic.
Aerobic bacteria (those that burn oxygen for fuel and leave carbon dioxide as a by-product — as humans do) found in the human intestine are friendly bacteria, which aid in digestion. These organisms thrive in the presence of hydrogen peroxide.
The second effect of hydrogen peroxide is that it provides singlet oxygen, which, in turn, transforms biological waste products and industrial toxins into inert substances by oxidizing them. This makes them easy to handle for the kidneys and liver. It doubles the rate of enzymatic metabolism in the mitochondria within each cell, thus enabling the body to cleanse itself of toxins and still have plenty of energy to handle the business of living from moment to moment. This increase in metabolism probably accounts for some of the antibacterial, antifungal, and antiviral effects of hydrogen peroxide.
Hydrogen peroxide is a part of normal metabolism. Your body produces it constantly. There are units in certain white blood cells called "peroxisomes," which produce H2O2. These white cells then engulf bacteria which cause disease and mix them together with these peroxisomes. They both then disappear as the singlet oxygen from H2O2 destroys the bacteria or virus. This happens naturally, without any help from outside sources of hydrogen peroxide.
When an infective disease becomes obvious to the person who has the infection the hydrogen peroxide defense mechanism already has been overwhelmed by the number of viruses or bacteria involved, and the immune system is into its secondary line of defense: the tedious process of analyzing the invading organism and making antibodies, which deal specifically with that organism.
The invention of man-made antibiotics, beginning in the 1920s, was a revolution in medical science. However, as a strategy for fighting infection it is clearly second best, as the body itself demonstrates. When the body is challenged with an infection, it first turns to hydrogen peroxide. Only when this fails does it turn to its own antibody production.
Conditions which can be treated with H2O2 include those conditions which can be treated with antibiotics, but without the serious toxicity often associated with laboratory produced synthetic antibiotics. Some of these conditions are candidiasis (yeast), viral infections, influenza, the common cold, sinus infection, Epstein-Barr virus and gangrene.
Hydrogen peroxide also has been found to dissolve cholesterol and calcium deposits associated with atherosclerosis. Therefore, it is a good treatment for vascular disorders. This can result in lessening or disappearance of angina, leg pain and transient ischemic attacks to the brain, which cause dizziness. It also can help reverse some of the damage left over by a stroke, if treatment is instituted early enough.
Research in the 1960s at Baylor University showed conclusively that intra-arterial hydrogen peroxide dissolves plaque in large arteries. This makes H2O2 a wonderful complement to EDTA in the treatment of vascular disease, as EDTA has been shown to clear small vessels and create collateral circulation around large vessel blockages. This combination is called "Chelox Therapy."
It also clears the lungs, in cases of emphysema, by producing oxygen bubbles in the alveoli (tiny air sacs in the lungs), literally lifting the mucus deposits up, so they can be coughed out.
Hydrogen peroxide has a remarkable clearing effect on the skin. After only a few intravenous treatments the skin takes on a translucent clarity usually seen only in children. In addition, hydrogen peroxide benefits asthma, leukemia, multiple sclerosis, degenerative spinal disc disease and high blood pressure. It is particularly effective with asthma, arthritis and back disorders.
All of these illnesses have a component of toxicity from accumulated pesticides, preservatives and organic industrial pollutants. Often the clearing of these toxins is enough to allow the body to heal, or at least partially repair itself. Obviously, where there is anatomic change such as in disc disease, this anatomic change will not be altered. However, what the person with disc disease, arthritis and other such illnesses is interested in is the disappearance of pain and the return of function. This often is possible with hydrogen peroxide.
Some doctors believe AIDS and cancer can be helped with hydrogen peroxide. The theory which explains benefits enjoyed by people with these conditions is that the cancer cell and the AIDS virus both are anaerobic and do not do well when exposed to singlet oxygen supplied by the hydrogen peroxide to water and oxygen reaction.
Much more research needs to be done in this area. Claims of cure should not be made unless they can be rigorously substantiated with cause and effect proven beyond any reasonable doubt. At the present time, we can say only that the oxidative therapies are valuable, arresting disease processes, but not necessarily curative.
Who will make use of hydrogen peroxide, and who will write it off as a hoax and pay for far more expensive, less effective, perhaps even damaging therapies? I saw a bumper sticker on a car at my son's school a few days ago: which read: "DO YOU THINK EDUCATION IS EXPENSIVE? TRY IGNORANCE!" People who will benefit from any of the therapies which are simple, effective and yet downplayed by the medical establishment, are those people who have educated themselves.
Those who refuse to educate themselves, never read, never try anything out of the mainstream of thought and insist on thoughtlessly following the "expert's advice," will pay through the nose for therapies which drain their resources and deliver half-baked results. It may be there is a segment of the population which is capable of nothing more. God bless those folks. Here is this doctor's advice: think for yourself.
If hydrogen peroxide is so effective, why is it not made use of in "modern" medicine? The reason is simple. Hydrogen peroxide cannot be patented. It is present in the ocean, it is present in rainwater, it is present in vegetables, it is present in every cell of your body right now. It must be classified as a food, because it is part of all fresh food of plant origin. Because it is produced in the human body, it is undeniably safe. Since it is a food and cannot be patented, there is no big profit to be made on it.
Pharmaceutical companies slave away to develop drugs which, although they may be less effective, can be patented. When a company can patent a drug it has a monopoly on the production and sales of that drug for seventeen years, time enough to make a fortune, as well as pay back the multiple millions of dollars it costs to produce the research to satisfy the FDA the drug is "safe."
By the way, approximately 125,000 Americans die yearly from drugs approved for safety by the FDA. Some of these deaths are due to individual unique ("idiopathic") reactions. Bruce Lee, a martial artist without equal, and a promising actor with a brilliant career in front of him, died in 1973 in the prime of life at age 32 from taking an FDA-approved headache pill, Equagesic. Any time a drug is synthesized in the laboratory and not derived from nature, this kind of reaction is a possibility.
There are uncounted hundreds of thousands of lives lost each year from toxicity well-known to the FDA, toxicity which is printed right on the package insert which comes with the drug. Most of these drugs are "chemotherapeutic agents," like AZT and Tamoxifen, designed to treat (not really) terminal conditions. They do not work to cure these conditions, but they do treat the conditions, getting rid of the patient by destroying the immune system — no more disease, but no more patient either.
What happens after a new drug is developed, tested and approved is that an advertising blitz is aimed at doctors to persuade them to prescribe this new "miracle" drug. Doctors do listen to this sort of thing. They cannot avoid listening, because drug company sales representatives by the thousands fan out across the country delivering literature on the new "miracle" drug to doctors' offices. They leave free samples to get doctors in the habit of prescribing this drug. They make appointments with doctor to bend his/her ear with a high- pressured sales speech.
Doctors hate this, and they love it. They hate to give up their time to the drug reps, they hate the high pressured presentations, and they love the free samples. This transaction between drug reps and doctors is a major source of the continuing medical education which doctors receive. This is their main line to learning what is "new,"and what is new is considered to be what is better! Such folly!
So how does hydrogen peroxide work? How can something so simple and so common as H2O2 be responsible for the outlandish claims made for it and the outrageous results reported by people suffering from such diverse disorders?
There has been much written about the possible benefits of shark cartilage in the treatment of cancer recently. The reasoning goes that because sharks do not get cancer they must have a secret, which may be contained in their cartilage. It is conveniently overlooked that whales don't get cancer, dolphins don't get cancer, starfish don't get cancer, octopi don't get cancer. In fact, none of the creatures of the sea (except those living in polluted water) get cancer. There may be something to shark cartilage. Sharks can live in polluted water and still are cancer resistant. The most common denominator is that all these creatures swim in sea water, which is rich in H2O2.
Were it not for industrial pollutants, herbicides, pesticides and food additives, we might be able to add "and human beings do not get cancer." However, even if we stopped polluting the environment and ourselves right now, we still would have environmental contaminants in our air and food chains for hundreds of years, so the diseases caused by these things likely are to be around for at least that long. The task now is to see if we can find some means of treatment and protection from this disaster until we can finally clean up our planet.
The most fundamental feature of a cancer cell is that it is relatively anaerobic. It needs sixty percent less oxygen than a normal healthy cell. It does very poorly in the presence of excess oxygen. All of this points toward the oxidative therapies as a decent treatment for cancer and a decent preventive measure as well. Apparently, cancer is the cell's attempt to survive under conditions of a low supply of oxygen. If your cells are well oxygenated, they may have no reason to transform into cancer cells. It may be that the way toxins promote cancer is by interfering with the use of oxygen by cells.
Most diseases we assume inherent to being human are results of the polluted chemical soup we all live in during this modern industrial age. Anything which allows the body to cleanse itself of these toxins will deliver you to the pristine condition of health you were meant to enjoy. Fasting will help, a pure diet of plant origin will help, vitamin supplementation will help, EDTA will help, intestinal cleansing programs and colon therapy will help, and so will hydrogen peroxide. Any of these approaches will help cleanse your body of toxins such as pesticides and preservatives, which are laced into the food you buy off the grocery store shelf.
When toxins are released from the cells of the body, they must cross the space between those cells and the outside. Ultimately, they exit the body through the lungs, the liver, the kidneys, and the pores of the skin. Detoxification can feel temporarily worse than the disease. It may be accompanied by headache, fatigue, grouchiness, insomnia and body pains for days or even, in very diseased states, weeks. Hydrogen peroxide is no exception. Be prepared for these kinds of results on your trip to a clear state of health.
People have been traveling to the baths at Lourdes, in southwest France at the base of the Pyrenees Mountains, since 1858 when a girl is said to have seen there a vision of the Virgin Mary. The waters at the baths in Lourdes are believed by many people to have miracle healing powers. Perhaps it is no coincidence these waters are loaded with, you guessed it, hydrogen peroxide. People go there to bathe in and drink the water.
How does one take hydrogen peroxide? You can go to Lourdes, or you can go to a good organic grocery store and buy a bottle of food grade (35%) hydrogen peroxide, dilute it and drink it, or bath in it. If you go to Lourdes, be prepared to shell out thousands of dollars. If you go to the grocery store, be prepared to pay a few dollars. Be sure to dilute it, because the 35% solution will cause burning of the skin on application, or internal damage, if you try to drink it.
If you take it orally, you should dilute it approximately ten drops in an eight ounce glass of water, two or three times each day, on an empty stomach (three hours after your last meal). If you take it with food in your stomach, the hydrogen peroxide will react with the food, and you will not get the benefit from it. Even if you take it on an empty stomach it reacts to the cells of the stomach wall, as well as whatever food fragments still are present, and you receive not only hydrogen peroxide into your circulation, but also oxidation products of H2O2 plus sluffed off cells from the lining of your stomach and miscellaneous food. Because of these considerations I cannot, and I do not, recommend you take H2O2 by mouth. I believe intravenous H2O2 to be far superior to the oral route of administration.
You also can bathe in hydrogen peroxide by putting a pint in your bath water. Be sure to stir it up well before getting in to avoid burning your skin. Many people with arthritis swear by this treatment.
If you are confronting a serious illness, or if oral and topical applications are not getting the job done, you can turn to intravenous infusion of hydrogen peroxide. Intravenous H2O2 is far more powerful than the oral ingestion or topical application. For this form of treatment, you must find a physician who is familiar with the proper preparation of pharmaceutical grade H2O2 in a bottle of sterile, isotonic intravenous fluid.
The infusion lasts ninety minutes. You will notice a warm feeling during treatment, not much more. The main effect of hydrogen peroxide infusions is that you regain your health through the increased ability of your blood to carry a high concentration of oxygen. In this sense, IV hydrogen peroxide therapy is an oxygen therapy. Treatments are one to three times per week, occasionally five times per week for an acute illness and, just as with chelation therapy with EDTA, the number of treatments needed depends on the nature of the illness with which you are dealing. From ten to fifty treatments will get the job done in most cases, and you should be able to maintain on oral hydrogen peroxide or the occasional intravenous infusion after that.
As I alluded to above, there is an exciting new development in the treatment of vascular disease, Chelox Therapy, which involves the combination of treatment with EDTA and H2O2, not in the same infusion however as they would oxidize/reduce each other. These two therapies work in different ways and cross react with each other, causing a thirty percent incidence of intravenous thrombosis. They can be given in combination to the same patient but not on the same day. The combination of these two therapies, given correctly, has been found to be more powerful than either one used alone.
Sources

  • Oliver TH, Cantab BC, Murphy DV, Influenzal pneumonia: the intravenous injection of hydrogen peroxide. Lancet 1920;1:432-433.

  • Root RK, Metcalf J, Oshino N, et al. H2O2 release from human granulocytes during phagocytosis. J Clin Invest 1975;55:945-955.

  • Finney JW, Jay BE, Race GJ, et al. Removal of cholesterol and other lipids from experimental animals and human atheromatous arteries by dilute hydrogen peroxide. Angiology 1966;17:223-228.

  • Urschel HC, Finney JW, Morale AR, et al. Cardiac resuscitation with hydrogen peroxide. Circ 1965;31 (suppl II);II-210.

  • Urschel HC, Finney JW, Balla GA, et al. Protection of the ischemic heart with DMSO alone or with hydrogen peroxide. Ann NY Adad. Sci. 1967; 151:231-241.

  • Gorren AC, Dekker H, Wever R Kinetic investigations of the reaction of cytochrome C oxidase by hydrogen peroxide. Biochem Biophys Acta 1986; 852(1):81-92.

  • Nathan CF, Cohn ZA Antitumor effects of hydrogen peroxide in vivo. J Exp Med 1981;154:1539-1553.

  • Manakata T, Semba U, Shibuya Y, et al. Induction of interferon-gamma production by human natural killer cells stimulated by hydrogen peroxide. J Immunol 1985;134(4):2449-2455.

  • Lebedev LV, Levin AO, Romankova MP, et al. Regional oxygenation in the treatment of severe destructive forms of obliterating diseases of the extremity arteries. Vestn Khir 1984;132:85-88.




The information in this article is not meant to be medical advice.
Treatment for a medical condition should come at the recommendation of your personal physician.


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引起头痛和头晕的肌肉!! - 枕下肌群(suboccipital muscle)





引起头痛和头晕的肌肉!! - 枕下肌群(suboccipital muscle)





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枕下肌群 (suboccipital muscle)


 


1.肌肉简介


枕下肌群与下颌关节轴椎骨动脉有着密切的关系,所以治疗时需要注意枕下肌群的紧张是否影响至椎骨动脉。


 



金門美兆診所 ''枕下肌症候群


 



金門美兆診所 ''枕下肌症候群


 


 


由于针刺枕下肌群有刺入椎骨动脉的可能性,施术者需要熟练掌握第1颈椎横突的触诊能力(第1颈椎横突位于乳突直下方),否则使用指压或肌肉拉伸的方法为更合适。


枕下肌群为枕骨、C1及C2(上颈部及头颅)运动的基础,且涉及脑神经的活动。


治疗枕下肌群需要理解与其连接的颈夹肌肩胛提肌斜角肌的相互功能关系。


 


2. 解剖位置及神经支配



金門美兆診所 ''枕下肌症候群


 


(1)头后小直肌: 寰椎的后结节 / 下项线内侧部


(2)头后大直肌: 枢椎棘突/ 下项线外侧部


(3)头上斜肌: 寰椎横突/ 下项线外侧部


(4)头下斜肌: 枢椎棘突 / 寰椎横突


(5)神经支配: C1颈椎神经后支(枕下神经)



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枕下三角区:由头后大直肌、头上斜肌、头下斜肌在枕下围成的三角区域,其内部充满脂肪纤维组织 。其上部由头半棘肌覆盖,也有椎骨动脉横穿此区域。若枕下三角区的脂肪纤维发生硬化会导致枕下肌群的问题。枕下三角区的疼痛的激痛点为斜方肌的第二激痛点。治疗时,需要把颈椎双侧同时治疗。


 


3. 功能解析


枕下肌群参与头部之屈曲、伸展、侧屈、旋转等关节活动的初始角度。因此治疗头部的活动受限,应先松解枕下肌群确保初起角度的运动后再进行颈部的矫正。在临床上,没有松解枕下肌的情况下对僵直状态的颈椎进行强迫性的矫正会使得枕下肌群受到损伤。


寰椎枕骨关节:约10度屈曲,25度伸展 - 头后小直肌,头上斜肌


寰椎枢椎关节:双向45度旋转 - 头下斜肌,头后大直肌


*唯头后大直肌参与头部的伸展和旋转。


4. 疼痛及激痛点解析


 



金門美兆診所 ''枕下肌症候群


 


患者自觉疼痛发自头颅,但无法表达具体位置或甚至表现为头部运动受限,其疼痛放射于枕骨内侧,扩展至眼眶部及额头部位。


枕下肌群疼痛类似于中风前疼痛(头晕,头痛),有些患者因此表现焦虑及恐惧,故枕下肌群在临床上被认为中风后遗症治疗的重要肌肉之一。


部分高血压患者出现头后部的沉重感、绷紧感时,枕下肌群与斜方肌上部纤维及胸锁乳突肌是首先要看好的肌肉。


由于枕下肌群与附着于C1~C4的肩胛提肌,常常诱发肩颈部的紧绷感、疼痛感及僵硬等表现。


枕下肌群处于紧张状态或受到损伤时可影响椎骨动脉向脑部的血流,这样不仅会引起头疼,也会引起对侧上,下肢轻度的麻木感。


 



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发布于 2019-03-24 21:18




































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最新








lilacann




请问老师,这种枕下肌群的疼痛该怎么治疗呢?



2020-01-01









刘峰




局部注射活血化瘀药物 小针刀松解



2023-03-18










zhou123456




按摩针灸中药外敷



2022-03-14











有风自男




求答



2020-03-25







 










 
















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