台灣醫學/Formosan Journal of Medicine
臺灣醫學會,正常發行
選擇卷期
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在維護精神病患之權益與保障社會免於危險精神病患之危害間，存在了相當大的矛盾與衝突。司法精神醫學所致力的就是要解決因精神障礙而導致的種種社會與法律問題，其中精神鑑定更是精神醫學臨床上的重要工作項目之一。本文首先簡介義大利、法國、德國等歐洲大陸國家，英美系統，以及日本及我國的司法精神醫學的歷史及現況，敘述傳統的概念與精神鑑定的實況。由於法界與精神醫學界對於司法精神醫學都有相當多的疑點，本文中特別提出：（1）法界與醫界的交點，（2）鑑定無訴訟能力或無責任能力﹖（3）司法鑑定與行政鑑定，及（4）病患的預後與復健等四課題來加以討論。近年來由於醫病關係及醫療中法律成份增加的關係，法律與醫學自然有需要去探索彼此間的關聯，法律與精神醫學間彼此互相交流的領域也自然而然擴大了，尤其是在美國已發展出所謂的法制精神醫學。為了預防精神病犯再三地發生犯罪行為，設立追蹤監視治療體系是極為重要的事。
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Abstract: The purpose of this study was to assess the psychological responses of previously infertile couples after becoming parents. Fifty couples attending an assisted reproduction program at a college hospital between December,1991 and February, 1992 were included in this study. The couples were initially interviewed during the treatment course by a self-administered structured questionnaire regarding demographic data, infertility history, and psychological responses, based on the Taita Symptom Check List. A follow-up questionnaire containing the same elements plus questions on pregnancy was mailed to subjects in March,1997. Twenty-four couples (14 who had become parents and 10 who were still infertile) completed both the initial and follow-up interviews, for a response rate of 48%. In the initial interviews, couples who became parents and those who did not were similar in terms of demographic characteristics and infertility history. Compared with the initial interview at follow-up husbands who had become parents had slightly elevated mean scores on the subscales of somatization, depression, anxiety, phobia and neurosis, while wives who became parents had slightly elevated mean scores on the subscales of somatization, depression, hostility, and neurosis. Compared with couples who were still infertile, husbands who became parents had a greater increases in the mean scores of the somatization, phobia and neurosis subscales on the follow-up questionnaire, while wives had greater increases in the subscales of somatization, depression and hostility. We conclude that psychological distress can persist or become exacerbated in previously infertile couples who become parents. The exact causes and possible demands for long-term nursing intervention deserve further attention and investigation.
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高粘度症候群為Waldenström巨球蛋白血症常見之併發症，高粘度症候群治療主要以血漿交換或血漿分離療法為主。血漿交換雖成效不錯，唯輸液相關併發症仍是潛在之缺點；雙重過濾血漿分離術以半選擇性方式除去血中大分子而緩解症狀，唯過高之血中球蛋白常會造成血漿成份分離器之堵塞，影響療效。在此，我們報告一例Waldenström巨球蛋白血症合併之高粘度症候群採用雙重過濾血漿分離術療法。當遭遇分離器堵塞時，即刻更換分離器持續分離治療，一個療程之後，免疫球蛋白M的清除率高達73%，且視網膜出血，頭暈，頭痛及胸悶症狀緩解。治療過程中未有相關併發症發生。因此我們認為，積極性雙重過濾血漿分離術不但有血漿交換之療效，又可避免血漿交換之輸液併發症，對高粘度症候群應是一理想之治療方式。
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肝腫瘤合併鈣化並不常見，它可以幫忙我們對腫瘤之性質做鑑別診斷。在本文中我們報告一例肝內膽管癌。這位69歲男性病人因腹痛、發燒而至本院就醫，腹部超音波檢查發現一肝內腫瘤合併鈣化，血液細菌培養出現克列伯氏肺炎球菌（Klebsiella pneumoniae），起初病人被診斷為肝膿瘍，然而在超音波指引下行肝穿刺生檢，病理報告結果是膽管癌。文中我們將對肝內腫瘤合併鈣化之鑑別診斷做一分析及文獻回顧。