Title The Caduceus: 啓思

OtherContributor(s) Hong Kong University Students' Union. Medical Society.

Citation

Issued Date 2011-09-16

URL http://hdl.handle.net/10722/138790

Rights This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

MEDICALSTUDENTS’CENTRE,SASSOONROAD,

HONGKONG.

Vol.3. No.II OFFICIALPUBLICATIONOF THE MEDICALSOCIETY,H.K.U.S.U. November,1971

SYMPOSIUM ON BRONCHOGENIC CARCINOMA

OnThursday,21stOctober,attheCityHallTheatre,a symposiumonbronchogeniccarcinomawaspresentedbytheAmeiicanCollegeofChestPhysicians,HongKongandMacauChapter.Thefollowingisasummary,compiledbyourreporters,of thepaperspresentedat thesymposium.

OpeningremarksTheopeningremarks,givenbytheHon.Dr.

(. H. Choa,pointedoutnowthattuberculosisis being broughtunder control,HongKongis facinganothermenace:a disturbingrisein theincidenceof bronchogeniccarcinomafor thelastdecade.Theresultof treatmentofthisconditionisstillpoor.Thegovernmentistryingherbesttocollecttherelevantdatas,encourageencouragefurtherresearchanddissuadethepublicfromsmoking.

IntroductionandEpidemiologyDr. H. C. Ho dealtwiththeepidemiology

of bronchogeniccarcinoma.Aetiologicalclassificationclassificationof cancercanbeasfollows:

I) Cultural2) Occupationalandenvironmental3) Genetic4) IdiopathicBronchogeniccarcinomais essentiallyan

environmentaldisease.It incidenceincreaseswithage.alineargraphcanheobtainedwhenthedeathrateis plottedagainstthe6thpowerofage,bothbeingin logarithm.Besidessmoking,airpollutionmightalsoplaya role. Asshownbythestudyin Denmark,theriskofgettingthecarcinomais higherin citydwellersthanruralinhabitants.Thepeculiarpointaboutthediseasein HongKongisthatthemale:femaleratioisvery close-3:2comparedwith5 to 10:1reportedreportedin thewesterncountries.Also,a highporportionof the femalepatients(30%) arenonsmokers.’Someotherfactorsmightcontribute,Researchalongthisfieldwouldhcfruitful.

PathologyThe pathologicalaspectwasexploredby

ProfessorGibson.Anatomically,it canheclassifiedinto:1) Central,arisingfromlobarbronchus,

producingcollapsewithsecondaryinfectinfection;closeapproximationto midlinemadesurgicaltreatmentdifficult.

2) Peripheral,arisingfromthe bronchusnearpleura,mightappearaslargenecroticnecroticmasssimulatinglungabscess:it mightinfiltratethechestwall,rootoftheneckand variousneighbouringstructures.

Histologically,it canbeclassifiedinto:I) Oatcellcarcinomaor smallcellanaplastic

anaplastictype mostmalignant,unsuitableunsuitableforsurgicaltreatment,usuallytreatedbyradiology.

2) Squamouscarcinoma— keratinisationusuallynotextensive,beingof littlerelationshiprelationshipto behaviour,mostsuitableforsurgicaltreatment.

3) Adenocarcinoma— mightbe mucinsecreting.quitecommonhere.

4) Polygonalor largecellanaplastictype.However,thereis discrepancyinthedistribution

distributionof varioustypesof bronchogeniccarcinomacarcinomaamongsurgical,radiotherpyandnecrospyspecimens.

lung.Butthereis noevidencetosupportthese01(1beliefs,it is evendubiousthatsquamousmetaplasiawouldleadtocarcinoma.

Spreadof thetumourtookplacethrough:

2) Lymphatic— 75%.of surgicalspecimensspecimensshowedlymphaticinvolvement.3) Blood— markedtendencyto invade

pulmonaryarteriesandveins40% ofsurgicalspecimensshowednakedeyeinvolvementof thevessels,especiallyintheoatcellandpcripheraltype.

4) Intra-alveolarspread leastcommon,onlyinalveolarcellcarcinoma,corpulmonalepulmonalemightresult.

Earlydiagnosisof bronchogeniccarcinomais veryimportant.Therearevariousancillarydiagnostictechniques:I) Cytologicalexaminationof sputumor

bronchialaspiration.Providedthe specimenis properlyobtainedobtainedandexaminedbyskillfulexpert,it is highlyaccurate,superiorto bronchoscopy.3 specimenson separateoccasionsare neededto excludecarcinoma.Therearecertainpitfalls:

a. Presenceof squamouscellsdidnotindicateindicatecarcinoma,it mightbeduetosquamousmetaplasia.

h. Falsecytoloicalresultflamniativediseaseof thecasionally.

Cytologyof pleuralfluidis lessuseful.2 Bronchoscopyandbiopsyofsuspectedarea.Their value is limitedas bronchoscopecouldnotreachthedistalbronchi.Thebiopsymighthetakenfromtheinflammatoryareasurroundingsurroundingthetumourorfromareanottypicalofthewhole.Thesurgicaltechniquehastobecarefulcarefulandproperhandlingof thetissuewasim—portant.3) Scalenelymphnodebiopsy.As a primarymethodof diagnosis,it is in—sensiti\e butthissimpleinvestigationcanconfirmcxtrapulmonaryspreadandindicatewhethersurgicalsurgicaltreatmentispossible.

Industrialcausesofcarcinomainotherpartsof theworldarealsofoundsuchasexposuretoasbestos,arsenic,chromium,nickel,radioactivesubstance,isopropyloil, coaltar fumes,petroleum.petroleum.Of these,onlyasbestosmightheof someimportancein theshipyardworkersoi textileworkersinHongKong.

ClinicalmanifestationsFirstlyDr.DonaldYupresentedthegeneralclinicalmanifestationsof patient’withhi-oneho-

geniecarcinoma.He hascihisstuds’on 39$patientsadmittedintoUniversity\‘IcdicalUnitfromI949to 1971. withemphasison featurespeculiarto HoneKong.However,thisgroupofpatientsmightnotbereprescntati\c of thewholeasthiswasa selectedgroupinsteadofa randomsamplc.Sex,age,incidence

Peakincidenceoccuredintheagegroup50-59 forbothmalesandfemals,Fromtheyearlyadmissionrate,maleto femaleratioas 1.9toI in 1960.and1.3:1in 1970.Therewasa lackof malepredominanceascomparedwithUnitedKingdom6:1

Shanghai(China)3:5:1(1959)Malaysia3:1(1966)

SmokinghabitsAbout66%of malepatientswereheavysmokcrs

smokcrs(greaterthan15 cigarettes/day)

ClinicalsniptornsTheseincludecough,haemoptysis,chestpain,

d\spnoea,clubbingoffingers,neurologicalsymptonis,symptonis,hoarseness.mediastinalobstruction,hvprtrophichvprtrophicpulmonaryoseoarthropathy.neckmass,1-lornersyndromeandpleuraleffusion.Sexandcelltypes:

male femaletotalAnaplastic 47.2% 47.2% 47.2%Squamous 34.8% 13.9%126.1%Adenocarcinoma %16.9 33.3% 24.2%Alveolarcelltype 1.1% 5.6% 3.1%Unspecified 32cases31cases63cases

Themostsignificantpointisthattherewasa highpercentageof adenocarcinomain femalepatients.Radiologicalappearance

Commonestbeinga mixedcentralandperipheralperipheralinvolvement.Peripheralshadowsaremorelikelyanaplastic.andaremoreliabletoproduceeffusionandmediastinalobstruction.Themajorityof hilarmasseswithobstructionsignareof thesquamoustype.Otherintermediatetypessuchasdffuseshadowsmightbeadenocarcinoma.

1.3%of caseshadnormalchestX-rayappearance.appearance.usuallysquamousinhistology.Comment

Thepatientswereseenatanadvancedstage,solatersignswereseenmorefrequently.Therewasa highincidenceof bronchogeniccarcinomaespeciallytheadenocarcinoniatypeamongfemaleshere,ahighproportionofthemwerenonsmokers.Researchalongthisfieldmightbefruitful.

ThenDr.RoseYoungdealtspeciallyontheendocrinologicalaspectofbronchogeniccarcinoma.Thevarioushormonesreportedtoheproducedbythetumour.espcciallvtheoatcelltype,are:

ACTHadrenocorticotropichormonePTHparathyroidhormoneTSHthyrotropichormoneMSHmelanocvtcstimulatinghormone(.onadotropiItSSerotoninErythropoietinOf these,thefirstt’.ohormonesaremore

commonlyencountered.In ectopcproductionofadrcaocoiticoptropichormone,a fullblownCush—ingssyndromeusuallydonothavetimetodevelop.develop.However,therema hemarkedweakness,in—creasedhloodpressure,h pokalaerniaandalkalosalkaloss. Plasmacortisol.urineI7 ketosteroidsand17 OHsteroidsareraisedandtheyarenotsuppisuppics%cdh administeringDexamethasone.Thepatientisusuallytooill fortotaladrenalectomyandhighpotassiumpotassiumsupplementis theonlys mptomatictreatment.

I) Directspreadsitated

— chestwallmightheinvolvedproximallyundermucosaneces—widerresectionof thebronchus.

24%werelightsmokers.16% offemalepatientswereheavysmoke

smokers.34%lightsmokers.50%non—smokers

occursin in—bronchusocPreviously.

ocPreviously.it wasbelievedandoatcelltypeswerecloselyingwhileadenocarcinomaarose

thatsquamousrelatedtosmokfromsmokfromscarsinthe

In ectopicantidiureticthereare hypotiatroeinia.anorexia,nauseaandmusclepressureisnormal,withno

hormonesecretion,mentalconfusion,

weakness.Thebloodevidenceofdehydra(Conliizued

dehydra(ConliizuedonPage4)

Page 2 CADUCEUS

LiiOtiL’iiStOtIll lost and byK.T.M.1 sUppt)sCflOOfleill Niis

MedicalSchoolunderstandshe suppressiveandtotalitaiantotalitaiannatureofModernWestc

Westcm society.IndeedaftersomeI3 earsofbeingpro—ecssedin thejufliorknovledeeknovledeefactories,everyoneenteringenteringthisMedicalSchoolhasalreadybeenmachinizedtoa er considerableextent.Inhere,the aresubjectfurtherfurtherto thefinalphaseof(iehumunuzItionbeautifulltermedtie intensivestudvofmedicine.Andwhentheleave,theyvill becomean—otherhatchof to-leggedsecond—ratecomputers.theirindividuality.liiimantv and

-mothered.(‘onformjt\is sacred.

1hosehoda:e toquestionand‘oicethefaintestdisapprovaldisapproval(iftheoldrottenstalesetof alues.nottomentionthepreciousfesshodaretoresist.falleasypre\to theharrassnientof thesstem.nottheEstablishmentonly.huteverysinglesegmentofthesystem.l hiso erdeveloped.erdeveloped.supercisilisedsocietyis builton thecruel andforcedconformityof evermanandwoman.Likeever\boltsandnailsandscrewsofa mechanicaldevice,theymlistobeythesame‘phvsicaIla\’,s’ in orderthatthesvs—

ternrna\workandsurvive.In returnfortheirownsur—ivalo.ithinthes stern.they

pa\thepriceofbeingtransformedtransformedinto humanmachines.machines.vithoutfeelingsoftheirown, ithoutaffectionsforothers.Thosewhotrea—stire their iitiman nattire,thosewhorefusetoconformthosewhoseetheultimatefutilityin scientificdevelopment.development.thosewhodonotwantto leada mereexistenceasamachinearereducedtothefringeofthesociety.Theyaretheoutcastsof thesystem,system,thehadelements,theundesirables.

Whogetsthebenefitoutof thesystem?No single

person.To thesocio-politicallvsocio-politicallvuninitiated,thismaysoundastounding.InourlifelongindoctrinationagainstCommunism,we are toldagainandagainthatit istheParty,thePolitburooreventhepartyleaderwhoisthefinalculpritforall thepoverty,poverty,sufferings,andsuppression.suppression.Weareat a losswhenwefindinourso-calleddemocraticsocietythesameafflictions.(lf indeedoureyesarestillopen.)CanwesaythesystemworksfortheGovernor,or the PrimeMinister,for thatmatter?TheCouncils?TheParliamentParliamentinLondon?No.Theansweris an emphaticno.Theyare huttheinstitutionalisedinstitutionalisedagentsofdifferentechelonsinthesamesystem.Therealvillainis,forthisCrown Colony, capitocolonialism,capitocolonialism,a tinyfeelerofthemammothWesternculturecultureintotheThirdWorldhutnonethelessanexceedinglyexceedinglyvast,perplexingsuperstructuresuperstructureofcoperations,consortiumsconsortiumsand governmentswhichbybringingintolineeachandeveryoneof the4millionpeopleherederivesitsbenefitfromthesystemandfeedsitself.OntopofallthisisthemorefrequentlyfrequentlydenouncedEstablishment,thosewhoholdrespectablepositions,reccivehandsomeincomes,commandtremendoustremendousinfluence,moralandactual,andwho,elatedbytheirapparentsuccessinthesystem,swearhardto defenddefendit.

In thissocietyofcapitalistscapitalistsandcolonialists,in thisageofknowledgeexplosion,andin thisstageof humancivilization,wecotoschoolnotto learnthetruemeaniligsmeaniligsoflifeandhumanexistence,existence,not to nourishanddiscoverhumannatureandourtrueself— affectionsand hates,emotionsandreason,instinctsandrationalactions—,nottoseebeautyin naturethroughliteratureand poetry.Instead,ourschoolsanduniversitiesarebutknowledgefactories(andeventhenonlythirdgrade)wherewearestuffedwithfacts,hardsolidfacts,meaninglessmeaninglessdeadrottenfactssothatweleaveasprocessedraw materialto join thearmyofspareparts,scramblingscramblingfor a filthyplaceinthemachineryof thesystem.system.Admitit,wearespareparts completelywithoutanyindividualitywhatsoever,replacebleat anymomentby anotherof our kind.Peopletalk abouttherecimentationrecimentationof peopleandlifeinCommunistcountries.Oursocietyhasaregimentationregimentationthatis equallycruel.Wearetoldto berationalin ourmoves,notto allow

ustoleada betterlife,butto suppressour instincts.Weareaskedtoreason,nottogainthefulluseofit,butto smotherour emotions.We are remindedthatweshouldhavea scientificmind,not to furtherourfellowmen’swelfare,buttoseetheirsufferingsinacold,indifferentmannerthatiscalledscientificdetachment.

My faith in humancivilisationis goneforever.The systemwill survive.Andmanwillsurvive.Buttheysurviveasmereexistence,existence,animatebut notliving.Whatisthepointofcuringpeoplewhenyoufindthattheyarenotanguishedhumansbutderangedsparepartsof a machine?Whatis the pointof makingfriendswhenyoudiscoverthattheyareindifferentandhostile?Whatis thepointof studyingwhenyouperceiveperceivethatit isbuthumiliatinghumiliatinganddegrading?Indeed,whatisthepointofallthiscivilisation?

IIIt comesas nosurprise

thatthemedicalprofession,a pillarstoneof thesystem.an Establishmentalmostby itself,demandsunyieldinglyunyieldinglyabsoluteconformityonthe part of its members.Buriedin a falsesenseofsuperiority,medicalmenclass themselvesin aseparatespeciesfromthelayman.Justbecausetheyaremedicalmen,theyindulgeindulgethemselvesin thefarcicalmyththattheyareservingpeople.Theyquiteconvenientlyforgetthefactthattheyclingdesperatelyto theuniversities,thebighospitals,maybedroppingahintthatthatis wheretheactionis,thatiswheretheircapabilitycanheexploitedto thefull,andtheyquiteneatlypaynoheedto thelamentablefact that theyconcentratein the citieswheretheycanchargeexorbitantlyexorbitantlyfor theirservice.Withoutsacrificeon thepartof thephysician,heisnot differentfromanyonewhohassomethingmarketablemarketableandthewholeaffairisnot in the leastanymorepraiseworhtythan anybusinesstransaction.Andthepooronesin thecountryside,countryside,in theslums,in thebackstreetsare left unattended.unattended.

I cometo thisMedicalSchoolwiththenaiveideathatI couldbecomea realphysician,onewhois likeany otherman,withhisshortcomingsandlimitations,withhisblundersandmistakes,mistakes,withhis fearsandfeelingsof uncertaintyIndeed,I just want to

(ContinuedonPage3)

VentolinTabletsorVentolinInhalermaybeusedVentolin(salbutarnol).whethergivenbymouthoraerosol,hasthreebasicpropertieswhich,together,makeit a realadvanceoverexistingbronchodilators:

ItisaneffectivebronchodilatorLi IthasarapidandprolongedactionLI Itactsonthebronchioleswithoutcardiovascular

cardiovascularinvolvement.VENTOLINTABLETSEachVenlohniablcicontainssalbutamof2mgassulphate.Suppliedinpacksof20,100and500.

separatelyortogethertopreventbronchospasmoccurring,orasbackgroundtherapyif spasmandwheezingareregularlypresent.Forbestresultspatientsshouldbeindividuallyassessed.VentolinInhaleristhepreferredtreatmentforacutebronchospasm.

VENTOLININHALERVentolinInhalerisameteredaerosol,delivering1OonicgofVentolinperinhalation,withaspecially,

designedactuator.Eachcanisterprovides200inhalations.

FullinformationisavailableonrequestVentolinisaTradeMarkGLAXOHONGKONGLIMITED

Ventolin - a real advance over existing bronchodilator therapy9thFloor,BlockB,Watson’sEstate,NorthPoint,HongKong.

Page 3 CADUCEUS

(ConlinuedfrontPage2)be on par with mypatient,albeitconversedintheartofhealing,butnotagod,nora saint.OnlythencouldI developa relation-shipwithhimthatis trulyhuman.Alas,a physicianhasto be a saint,evenifonly a proppedup one,reassertedtheEstablishment.

[hefireofnonconformityinsidemyselfblazeshigh,the hatredtowardstheEstablishmentturnshard,Iheedmoreandmorethecall01 revolution,the call ofaction.ButI ama weakman,inbothbodyandsoul.And I am nota capableman, only a bookworm.I here is nothingmorevaluablethancontrontationwiththeEstablishment,tohardenmyself,to makemyselfstrongerandtougherin the struggleto destroythe system.In the 7-7Incident,forall theseyearsolmylife,I firstdiscoveredmyscif:I amliberated,freedhuh all the bondswhichthisworldlaysonme,freedhornthecultsofreasonandcomposure.

Whereasall my fellowstudentsrushedto thebarberbarbershopto cuttheirshorthairevenshorterto welcomewelcomethenewterm,I madeupmymindandreassertedto myselfthatI wouldnotcutmyhair,I wouldkeepit thewayI liked,nooneasgoingtochangethat.I

appearedcalmandcomposed.composed.But deepdown,myvcakselfwastroubledandepset.A confrontationwiththeDeanis quiteanothermatterfromonewiththecops. Nevertheless,theurgetoconfront,tostagealacetofacestruggleandthedesiretoprovemyselfwereso overwhelmingand theIiidetcrminatenature,typicalofmyself,whichwasforeverat workin somehiddenrecessesrecessesof mymind,wassodominantthatI driftedoilwithouta haircutandattendedattendedthefirstlecturewithmyhairintact.

Thefirstweekprovedtobeanordeal,Thehardestlimeinmylife. Thefearofanddesirefora showdownwiththeEstablishment,thejceringsof my fellowstudents,students,the innocentbutmisplacedfriendly admonishingsadmonishingsof thosewhosimplydo notunderstand,myimaginedvisionsofthemlaughingat my back,and(heirplayfulteasingsmademefeellikeI hadneverfeltbefore.I was depressed.Irustrated,andcrosswiththeworld.Butthatwasapricelesslesson,drivinghometo methewaythesystem worked. TheEstablishmentdoesnothaveto hire secretpolicetocheckeveryboby.It doesnothavetopunishnonconformersnonconformersright away.Bymakinga moraljudgementon thenoneonformer,pro..claiminghimmoralisticallywrong,the Establishmenthas as its watchdogthewholecommunitywhohavebeenindoctrinatedthatway.Tl eonwil1lhWuld be

againstthe nonconformerwhowouldbealonein hisstruggleandthiswouldbeardownonthelonetrespasseras a boisterousonslaught.Thepressureisonthemindratherthanon the boby.The suppressionis byhumiliationratherthanbycoercion.It is subtleandintangibleyet immenselyrelentless.

Withall thisanguish,Ifoundconsolationandin-deedpleasureinfindingtheclasstullofclownsshoutingat eachother,commentingon eachother’shairanddoingmyriadsofothersillythingswhichdo notmeritrecordhere,amusingmy-selfwiththeirgutlesssub-missionto authorityandthelackof desireto defyauthority,any fornl ofauthority.

IllThesituationwasoneof

stalemate:theconfrontationseemedsonearandyetappearedappearednot to matetialise.LikethecondemnedOflthedeathroll,thewaitfor thechargeof theEstablishmenttwistedand strainedmymindto breakingpoint.Iwassotorturedbythecontradictorycontradictoryand conflictingnatureof my temperamentthatI thoughtI wouldsuccumb.succumb.Myferventobsessiontodefytheestablisheddrovememadlesslyonandyetthedeep-rootedfearofopendefiancedefianceandits consequenceconstantlymadeitspresenceknown.TheclimaxfinallycamewhenProfessorMacFadzeanMacFadzeandeliveredanintroductoryintroductorytalk.I couldstillrecallrecallthepictureofmyself,atimidlittlenothing,hidingrightat theback,lesttheProfessorshouldseeme,ratherthanwalkingrightuptometosay,‘Goddanioldsucker,hereI am.’

Hewasanoldman,weakandunsteady.Hishairwasshinywhiteandwithahloridfaceit lookedevenwhiterandshiner.He spokewithvisibleelTorttomakehimselfhimselfheard,changinghisspectaclestoreadtheOath,both the classicalandmodernversions.Withvigorouslyvigorouslytremblinghandsamidgrosslyunsteadygait,hisspeechinterruptednow& thenbya fewcoughs,liemanagedto standthroughthe15minutetalk.Pooroldman,aftera delicateopera—(ion,I saidtomyself.

He openedby saying,“Thereare certainrulesthatyoumustobeyin thisMedicalSchool.Longhairill notbetolerated.”He

wentonandexplainedthata physicianmusthe‘sober’inhisappearance.Notthathis sternattitudetowardlonghairand‘sober’appearanceappearancefrightededmc,northat the threatof beingkickedout of the wardssoftenedmydeterminadon.What1wasfeelingthenwasthat I couldnotpossiblyworkmyselfupto a headoncrashwithhim.Hewasa frailoldmanandI havenothingpersonalagainsthim,knowingthathewasjust anothernon-human

4gcntof theEstablishment,Itstrontlineintamitry.1heiastremnantsof themiddleciassvaluesinstilledintomynumbleseilwereworking,andI toolnoteofthesense(it scholarship,dignityandsincerityheconveyed.Ihcwayneheldthepracticeotniedicmflein hignesteem,nd thewayhe tell abouthisprotessionimpressedme.i-flUI believeinHissincerityin assertingthenecessityota sobcr’appearancetogiveconfidenceto the patientOIICtreats.

However,sincerityisonethingale prmncipiequiteanotnerJohnsonmightin—deednaveDCCnsincereinhisdisbeliel01CommunismBut it couldnot possiblyjustifytheuseof thousandsof tonsof bombs,mortar,andartillerylirewhichfelllikerainonVietnamsothatiiiihioiisof underciothed,under-lcd,Vietnamesemen,womcii,andchildrenranucsperatelyforsheltereveryday and night. Nigeriamightifldeedhave beensincereinkeepingBiafraintheFederation.Butdoesitjustify tile genocideinBiafra? ThereforethatProfessorMacFadzeanissincerein deniandingshorthairfromUSor, for thatmatter,bughair,doesnotnecessarilynicanthatshorthairis inherentlygoodorbadoranything.Mybeliefin thelengthof hairhavingnothingto do withone’sablity,intcrgrity,etc.,etc.,standsunshakenbutindeedicalTirmed.True,haircontrolcontrolis symbolicof theEstablishment’sdemandforconformityon thepartofthe commonpeopleandcaringone’shairlongthussignifiesa honestcivilprotest.protest.

Thestereotypingof manin modernsocityis ferociouslyferociouslypursued.all to thebenefitof the continuedexistenceof the system.Peoplebragabout(liefreedomsfreedomsthatareguaranteed,[hemanythingswecandointhissytem,andhintdarklythatCommunismwipesoutallthat.Oursystemthrivesontheregimentationofmanas muchas Communistcountries.Everyonewearsties, shirtsand businesssUits,variatioiiof whichisminimal.Sonexttimeyoulaughat theascetic‘Libera—[ion outfitof Chinathinkof whatvon ousclfarealloedtoputon.

The realsignificanceofwearingone’shairlongisthusthedeclarationof waron the Establishment.(liepursuitof opendefianceofauthorityandthefirststepin theliberationof (lieselffromthecageofthesystem.The valuableexperiencegainedthroughwearingyourhairlong,whichistrespassingtrespassingintotheforbiddenlandof the Establishment,ismostdesirableoralmostindispensableindispensableto everymanwhowantsto befree.

IvMywarwiththemedical

Establishment,personifiedin

the form of Prof.MacFadzean,MacFadzean,is doomed.IknowI shallbe as meekandsubmissiveasa child,at bestholdingona littlelonger.I knowI shallcutmyhairtoacceptablelength,I knowI shallbejustanotheranothermedicalstudentontheassemblyline to be processedprocessedandhammeredintoa curingmachine.Butletthisworldknowthattheburningflamesof rebellionof thismanwill neverbesmothered.Let (hisworldbeawarethatanunscrupulousunscrupulousmanlike myselfwhocouldforsakehisprincipleto evadesacrificeis goingintoa preicssionthisworldrespectsand adores.Leteveryoneknow that myradicalizationis onlytemporarilytemporarilyhaltedandwillgoon andon untilthetotal

destructioneitherof myselforofthesystem.

I shallclosethispiecewitha fewwordswrittenbya mannamedJamesSimonKunenof whomI do notexpectany of you haveheard.Indeed1 do notexpectanyofyoutounderstandunderstandmeor whatI have

ritten.‘My fathertalksabout

thebadassociationspeoplemakewhentheyseesomeonewithhair. ButI saygreat.1wantthecopstosneerandtheoldladiesswearandthebusinessmanworry.I wanteveryonetoseemeandsay‘Theregoesanenemyofthes(:mte’,’costhat’swhereI’mat,aswesayin therevolutionrevolutionhiz.”

JamesSimonKunen,Oneyearmysenior.

(lot tiuit wiw L)rirn . .

Duringthe5thDeansUndcrgradMeeting,the pro—hlcmof car—parksin QuectiMaryHospitalcompoundwasbroughtup.It wasnotedthatmanymedicalstudentspus-sessed‘parkingpermits’whichwereout-of-datepermitsorxeroxcopiesorpermitsstuckoncarswhentheywerepurchasedpurchasedby niedicalstudents.It mustbeemphasisedthatdrivinga car with a l)arkingperniit hearinganotherper—SOflSflamein orderto gainentryintoQueenMaryHos—pitalCompoundis equivalentto ‘personation,whichis aforniof forgery.Thelatteris a graveoflense,punishablebylaw.Anystudeiitfouil usinga false.parkingpermitisliableto prosecutionin courtandif heor sheis foundguiltyof personationor forgerythiswillhaveseriouscon—SC(.ItICiiCCS(Nihis01’hersubsequentprofessionalemploy—Ineiit.

Moreover.it wasFoundthatnianycarsof theniediealstudentsborebadgesniarked‘MD’ or ‘BMA’. iliesearebadgesdesignatingthe prol’cssionalqualificationof theowner.Undernocircunistancesshouldniedicalstudentstry to avoidbeingcauglufor traflicoffensesby stickingsuchbadgesOfltheircars. If theyarealreadyfixedtothecaisaIR!couldnothereniovcd,niedicalstudentsarcadvisedtocoverthemuptoavoidabuse.

..........I.. E D I T 0 R IA L ............: LUK’SVERSUSLEE’S :: Theone-manelectionoftheUnionExeceutives:: forthelastfewyearshaveneverbeenalltogether:N toointerestingfor us unionmembers;the can- :,, didateshavingto faceno competition,and us

beingofferednochoice.At lastlong,it is heart-warmingto seethat :

: therearetwocabinetes,Luk’sandLee’s,runningfornextsession’sunionexeceutives.

I By and large,Luk’scabinetprobablyrepre-:sentsa moreradicalwingof ourstudents’union.•‘; UnderLuk’s‘reign’,it canbeforseenthatHKUSUI willcommitherselfmoreandmorein socialand :: politicalissues,andtheywill alsoendeavourto: arousetheinterestoftheunionmembersinthese:

respects.However,if theoresentapathytowards:., theseaffairsremainsprevalentamongthegeneral:studentbody,actionstooboldonnartoftheunion.

centralmaynotbetrulyrepresentativeofthecon-sensusofthestudentsasa whole. :

Ontheotherhand,Lee’scabinetcertainlydoes:not representany extravagancein speech,nor: aggressivenessin action,andhispolicyfor next :

yearisprobablya conservativeone.Thiswillmean:thattheUnionwillbecautiousinplanningeachof •hermovesandavoidgettingherselfinvolvedinaffairsthatthe studentsarenotexactlytooen- :thusiasticabout.However,suchnolicymayalso •

: impliesthatthesocialandpoliticalconsciousness:: ofthestudentsasa wholewillcontinuetoremain• in itsinfancy,notto mentionthepossibilityof a: reconstructionof theivorytower. :• Sothereweare,fellowstudents,thechoiceis :: yours.Thinkcarefullyonwhatyouwouldprefer:: andcastyourvote! :: Thisviewsexpressedbyourcontributorsarenot :• necessarilythoseof theEditorialBoard.

TheEditorialBoardwishesto thankthespecialsupportof theGlaxoHongKongLtd. :••••••.•••••s•••••••••••••••a.• I••I•aRe.sI..

Page 4 CADUCEUS

(e’nIinuc/(l,n Pa.c’cItion.Restrictionof waterintaketo 500mIsisusuallyeffectivetoimproethementalconditionandmusclepower.Largedoseof 9 -flurohydrocortisonc-flurohydrocortisonccanalsoheused.

Thetrueincidenceofendocrinemanifestationisdifficulttoassessasthesearenonspecificandeasilymistakenasgeneralmanifestationsof themalignancy.Sothecliniciansshouldhe on thealertfor:

1) Theendocrinemanifestationmightbethefirstssmptomof anocculttumourwhichis amenableto treatment.

2) Theendocrinefunctionof thetumourmightaddtothep:lniarysymptornato—logyof themalignancytocausemorediscomfortof thepatient.Recognitionandtreatmentof theendocrinemanifestationmanifestation‘ould makethelastdaysofthepatientmoregratifying.

3j In adrenocorticotropichormoneproduc—(ion,theprogressof theprimaryandmetasticspreadarcaccelerated.

Finally,Dr.S.C.Sotalkedontheneurologicalneurologicalnianifcsta4ionof bronchogeniccarcinoma.

Classificationof non—mc.tstaticnetirologiclilmanifestation(BrainandAdamsI965):I) EncephalopathyI) Multifocal!eucoencep1alu)aLl1\: rarest,rapidly

rapidlyfatal.(2) Diffusepoliocnccphalopalhy

a) vith mentalsvmptom:hitarue,iion—specific.

b) subacutecerehellardegeneration;nystag—nus,heniihalIisnus.

c) brainstemlesions.

II) MyelopathyI) Chronicrnyelopath

a) Longtractdegenerationb) Longtractdegenerationand neuional

degeneratione) Motorneuronclikedisease

1roximalmuscleweaknesswithwastingandfaseiculation;lowerlimbsinvolvedinearlystage.BothupperandIo er motorneuwilcsigns.Protractedcourse.(lCliflitCtendencytoarrestif primaryremoved.

(2) Subacutenecroticrnyelopathy;rare,rapidlyfatal.

(3) Nutritionalmyelopathy.III) Ncuropathy(I) Sensoryneuropathy‘ith dorsalcolumnde—

generation.(2) Periphenilsensorirnotorneuropathy(poly—

neuritis).Thiswasthecommonestmanifestion.(3) Metabolicendocrinenutritionalneuropathies.1V)Musculardisorders(1) Polymyopathy(2) Disorderofneuromuseulartransmission.

a) myasthenicmyopathywithparadoxicalpotentiation:Repetitivestimulationofmotorncuroncshowedprogressivedecreasedecreaseinactionpotentialwhenrateofstimulationisslow;withrapidstimuLi(ion,stimuLi(ion,facilitationoccurred.It differsfrommyastheniagravisasbulbarsignsare minimal,easyfatigabilitywithwarmingupeffect,diminishedreflexes.prominentdrynessof mouthandminimalresponseto neostigmincbutmarkedimprovementwithguanidine.

b) myasthcniagravis(3) PolymyositisanddermatomyositisActiologyofcarcinomatousneuromyopathy:I. Carcirtotoxin(Oppenheim1868)2. Virusinfection(Hensen1954)

Thispostulatedthatinthedebilitatedpatienta normallyharmlessviruswasactivated.

3. Antigen-antibodyreaction(Russel1961)Thisis themostfavouredtheory.It ispostulatedthattumourantigenscausedantibodiesantibodieswhichmightcross-reactwithnervoustissue.

4. Metabolicdisorder(BrainandHensen1954)At present,thereisstillnoevidencetosupportsupporttheabovetheories.

Theneurologicalmanifestationmightbethefirstsymptomandsinceit is bizarre,theclinicianclinicianhastohavea clearunderstandingof it forearlydetection.

SurgicaltreatmentThisas delieredbyDr.JohnLeung.Hisstudywasbasedon260patientsadmitted

intotheUniversityThoracicUnit,allhavinghistologicalhistologicaldiagnosis.

Themaximumagegroupalsofellon50-59.Themalefemaleratiowas1.7:1Smokinghabit:inmale92%smokers.56%

infemaleHereDr.Leungsuggestedthatthehighpercentage

percentageof fcnialcnonsmokersmightbeduetoexposureoflungtothefoulatmosphereproducedbyill fittedkeroseneburnersin badlyventilatedkitehens.

1his asjusta suppositioaastherehasbeennoexperimentalstudyandciinicalevidencetosupportsupportit.Pithologofthespecimens:

Anaplastic(includingoatcell)I I(1Squanious6I

nocarcinoma45;\lco1ar2SarcomaILneLissified39

I)urationof illnessIeforesurgery:lessihaiiI month271-3iflOliths753—6iiioiit]is(m4(—12months38longerthan1year56

Ofthesepatients.68wereinoperablebypre-opera—tiveassessment

73vcueinoperableat thoracotomyPneunioncctonivdonein 41Lohectomin63Segmentedresecta)il 1\\edgeexcisionIExtendedradicalexcision13

O erallresectahilityrate46Segmentalrcscctiomiandwedgeexeisiomipov—

cdtohea inistakenchoiceasbothpatientsdied: recurrenceoftumour3-6monthsafteroperation

Also,theextendedradicalexcisionwasanunsuccessfulattempttoextendthehorizonofre—sectionto includechestwall,pericardium,diaphragm,diaphragm,partoftheatriumoroesophagus.Noneci thesepatientssurvivedmorethan2 yearsand[liepatientssufferedevenmoreduringtheirlastdays.Resultsof surgerywereasfollows:

Mortality55 yearssurvival8 (11% outof75rescctions)10yearssurvival315yearssurvival1

RadiotheraphyandChemotherapyDr.RudyKhootalkedonradiotherapyand

chemotherapyof bronchogeniccarcinoma.Hepointedoutthattheseareonlysecondarylinesoftreatmenttosurgery.Thesecasesmusthavehis—tologiealconfirmation.Theinoperablecasescanhedividedinto:

suitableforradicalradiotherapysuitableforpalliativeradiotherapyamidchemotherapy

Criteriaforradicalradiotherapyarc:I. Smallgrowth.confinedtolung,inoperable

inoperablebecauseof promirnitytocarina2. Smallgrowth,confinedto lungand

niediastinum.3. Growthconfinedtolungbutthepatient

isoldandof poorrespiratoryreserve.4. Thevolumeofthetumourwaslessthan

10x 10x 10cm.It is contraindicatedin widespreaddisease,

presenceofotherfociandpleuraleffusion.Pre-operativeradiotherapymightconvertinoperable

inoperabletumourtooperableone.Post-operativeradiotherapydoesnotincrease

survivalratebutmighthelpinanaplasticandoatcelltypes.

Cobalt60isemployed,aslittlenormallungtissueisincludedin thefieldof radiation.Outof288patientstreatedbytheUniversityRadiologyunit,only10 patientsweresuitableforradical

course(3.5%), 7 referredforpostoperativetreat-ment.2 arealive.one8 yearswithanaplasticcarcinomatreatedby radicalradiotherapy,theother9 yearswithanaplasticsarcomatreatedwithlobectomyandpost-operativeradiotherapy.Complicationsof radiotherapy:

I. PulmonaryfibrosisWhenlocalized,symptomlessthoughvlsi-bleonX ray.In some,a flaringfibrosisoccurscx-tendingoutsidetreatedvolumeproducinggrossdyspnoea,untreatable.

2. Irradiationoesophagitis,somedysphagiainevitableinradicalradiotherapy.

FroniastudyinNaniLongHospital,patientswithinoperablebronchogeniccarcinomawereputrandomlyOilthefollowing4 ways:

I. Waitforsignificantsymptombeforeanti-cancertreatmentstarted

2. Immediatetreatmentstarteda) radiotherapyto maximumtissue

toleranecLi) chemotherapywithmustinee) radiotherapy-i--mustinetreatment

Iherewasnosignificantdifferenceamongtheresultsobtained.Therefore,notreatmentisthebesttreatmentinpatientswithadvancedcarcinomawithoutmuchsymptoms.

Palliativeradiotherapyis usefulin thefollowifollowingconditions:

I) SkeletalnietastasesShortcourseof radiotherapysuccessful.

2) ParaplegiaduetospinalmetastasesEmergencyradiotherapyrequiredwithin48 to 72 hours,uselessin establishedcase.

3) Cerebralmetastases.4) Pancoasttumour

Maximaltolerateddoseisgivenwhenpainwassevere.

5) Superviorniediastinalobstructionwithprediiisolonebeforeradiotherapy.

(‘i) Pleuraleffusion.Butit isnotusefulinwidespreadpleunilpleunileffusion.Thepracticeofintrapleuralinstillationof colloidalgoldwasabandoned,abandoned,bettertreatedwithnitrogenmustard.mustard.

Chemotherapyisol’liniitedvalueonly. itis eniployedwhenradiotherapyis notavailableorthepatientwastooweakforit. Bestagentisstillalkylatingagent.FromtheclinicaltrialinNam Long,cyclosphosphmiceis as effectiveaswhenit iscombinedwith5 fluorouracil.

EPILOGUEDr.J.K. Craig,DeputyDirectorofMedical

andHealthServicesdidthegeneralswimdngupandexhortedthepublictoabstainfromsmoking.

Thevoteof thankswasgivenbySisterM.Aquinas.Beforeendingthe3 hoursofillustratinglectures.sheaskedthedoctors,especiallythegeneralpractitionerstohaveclinicalalertnessforthedisease.Earlydetectionisofvitalimportancein thetreatmentof bronehogeniccarcinoma,

DearSir,CORRESPONDENCE

I wasveryinterestedtosectheletterfromtheAnaesthesioiogistonpagethreeof yourSeptemberSeptember15,1971issuein whichhecomplainedthatinyourarticleaboutGranthamHospital,theAnaesthesiologistwasnotmentionedatall.I wasalsogratifiedto reactfromyourcommentsthat‘theroleof theanaesthesiologisthasbecomesoindispensabletoa hospitalthatthewriterof the‘GranthamHospital’hasobviouslytakenhispresencepresenceandhisworkforgranted.”

However,asit is consideredthatnotonlytheroleofanacsthesiologist,butalsotheroleofsurgeon,physinian,andallotherbranchesofMedicineMedicinehavebecomesoindispensablethattheirpresencepresenceandworkaretakenforgranted,it wouldappearthat,takingyourexplanationat i facevalue,it willinfutureonlybenccessarytoprinttheHeading“StaffingofHospital”andthenleaveallthefollowingspaceblank •

I.

I havethebonouttoremain,‘uis ,tathfI!lly,.AnodrAnaq.

香港大學學生會

醫學會

月刊

第

三

第十

九考一年十

月 期 懸

踏著沙宣道，一月過去了，片片黃葉乘西風飄下，始覺秋意

茫濃，夏去秋來，這就是生命的前進。

起初總是覺得很矛盾，著寶很久也未能接受自己是正在讀醫

的事實，明友們說你不像，但當教授說過：口ere.sn。artin

膩ediC。e我就必須要很實在地接受和明白自己是做著些什麼

，於是就將我小包囊裹的害，詩和育樂好好的收拾起來，放在架

卜的一角，還括L一枝小紫紅玫瑰，告訴自己不要再徹夜細讀張

秀亞，輕念辛協的一懷思一·或臥在床1：聽叫oni膩

itchell聽

Beatles，或斗你不懂可壯我的力量是如此微弱，而時問是如

此忽促；我必須要在感情卜抬棄另一樣如果我要選擇另一樣的話

。比如現在換巨甩讀著幾頁

Synapt-c

Transmission，總會比

塗這些束西更成功更有擁。

我從來沒仃T。。

craZy

abol"t讀醫。記得當時貝騷必須要

下一們重大的抉定，我曾想如果我木身沒有多大興趣教書而確實

富起教員來，我亦曾做個好的牧師，因為我明白到它工作的意義

，所以我會螂敬和樂於從事自己的工作，合田然從旁影晌的人為力

量亦不小，我深深地體偉到父母．底的希望，另一方面偶交的藍

人明友，他們仃青軀體卜洶炎缺，但仍然努力地生活工作，希望

帶給別、快樂，這儿．一都給予我縱限的鼓舞f11信念。很可！蹴的瞌我

著實亦澎漸喜歡J、過門俟·問。

抱若）伶訢坐的情懷，妒倫細斤尺一切訢的人新的事物，事寶

-l：每天荒淺嘗到有蒼祈趣味的生活，'-接觸每一張訢臉孔，都有一

個故事。講師們各有各格，當然有收沉悶乏味得寶在不敢儿維，

但尤愛士。超先生很有折味的B丫talks和漫書。同學方而，史有各

種不同的；、、物，有很友善可刊，有內含拒久詢，男孩子仔隱定酒

騰洶，卞有軾一叩一計l;J我·表現的。

不必，【講室總尼濫化樣奇冷，少上氣滲人每一個毛孔·令久師糾

不已。最俊為一刊，昏冷，門，身必的男孩子州塗目字卜門ergt：話，百

多張險孔的待一伐有收恪感覺，突然發覺周圍的都是將會在你生命

某一段路程州你七在一枕詢人。肥得巾請，、干、學時要鑄自己做的

豚

一篇文章內，曾期望多姿多釆的學府日子，交上很多很多除談天

氣外還可以握手談藝術，生存，國家和很多其他話題的朋友，但

畢竟我們不再是上小學一年級純真的孩量，一起跳幾同橡根繩便

可以成為好朋友的那種，我們已經長大了，大得有了成人那一份

成熟但頗虛偽的潛慧識和自我意識。冒昧探敲別人的心扉是會很

容易傷害別人和自己的，人的感情就是一個如此麻煩複雜的，交

結也就隨得它的自然飄流吧！反正你永不知道風是從那一方向

吹l·見到一草同屬於一個時室的人，特別有一份興奮喜悅，年青

是生命的力暈，我們是和平，愛和花的一代，棲身在這小島L無

論生命或是生活上都有著共通的地方，歷史的血脈，黃河，長江

，天山，廣漠草原都是在我們體內奔騰著，你感應到嗎？釣魚台

壯我們一個開始，終點還看不著，那麼就以懷望依歸的心情，毋

亡心中國，祝一幅她！

明友，年輕的朋友，我們在未來口子中會有無數的偶遇相逢

，就在這些偶然中，請不要忽忙，忽忙該在中環，該在尖沙咀旺

角o想他？J和自己走遠了內明友，大學就好像一個站，有人下車

有人上來，有久換上一列往另一方回走的，也有趕乘下一列的；

每日在疲乏的歸程，昔日與渡的lla天，雨天就會在腦海裹浮現，

我是個非常卷想緬懷過去的人，無限懷念那星夜，灘頭和那陋屋

夜談，很感謝霖林我剪了個很頗的頭尖，李受了一整個寫意的夏

大。為什麼我們總騷要很無可奈何地揮手？毋忘給大家一點訊息

李樹芬樓實在沒有茫麼地方可提·就貝喜歡附近幽雅沿山臨

海的小路，清晨晚風都給久清新舒適的感覺，不過那些環繞在這

裘的日子中，生活是愉快的，遺憾的是功課可要急追。l'pe爾亦可

在不可預知的生話州斷中找尋得詩相美麗的人，我會感到滿足，

事實但否，我還不鉑道。

最近瑪麗醫院執行一項說大不大，說小大小跑新攤政：魷是騰生

們所佩戴的名牌J皆一律白底黑字，並且中英文並厝．此舉不驕

縮短醫生病人之間之隔閑，並且將一向為資深大醫師們所專到的特糧

名牌加以普及，除學生及實習醫生們外無遠弗屆。余以為如此德政。

適宜予以推廣，不若各醫學生亦各配給白底黑字·中英對照之名

牌乙塊，lst實B試前者冠以紅色L字，試後則改為綠色。待畢業

後刪L字而發黑牌：換言之。五年醫科生涯，先為紅牌生，綠牌

生而晉升為黑牌大師傅，再進而為白牌大醫師。如此這般，則實氏界

中e應於何時起才可繫於白領上等等無聊問題，再無討論之價值。由

是實edic精神得以促進：天下太平，蒼生幸甚矣！

×

×

×

醫學生中心，由於擴建關係，通路屢有修改。現時往餐廳，圖書

館，宿舍等的通路，比前之L。。9and

winding

road，更長，更曲

折，使飢腸輓輓，身軀疲痛之各位同人，有長路漫浩浩之嘆，雖

努力加餐茶亦有得不償失之感。據說將來新廈落成後，休憩室內將

有電視，音響設備等裝置。可是對現時留駐實江片

Centre之同

學來說則有未見其利先蒙其害之感，因為新廈遮擋視錢，欲速眺

窈窕淑女，指而論之皆不可得也。有人以為將來新廈天台應用作集會

，猶其是月光舞會之類。竊以為此意甚佳：從今而後，實。魚C

BBQ,

SOCialg黑，週年拍攝留念等盛會此天台當可大派用場，無

耑假外求。願當局一一一思！

不過開舞會之際務請各位駑車人仕合作，純用低燈，以免破壞情

調，大煞風景，是盼！

×

×

×

自從醫學會之r小兒護理指導，一舉行之後，各方好評如潮，咸嘆

EnCore，不在話下，不必阿丁再贅。頗值一提者乃為本人之重大發

現：即撤多參加該指導之各位學兄，皆染上一種急性心臟病。此病學

名為

Roman江c

Heart

Disease，簡稱RHD。照本人研究所得，此

病一般多見於青春發動期，男女患者比例約付1。其病源雖尚未能確

定，但相信r異性接觸有關。其病徵：

（一口關節痛：尤以腰及下肢為甚，蓋此等關節於舞會中最工nv

0一vedon二）發熱：面紅耳赤·時而喃喃自語，時而手舞足蹈，或閉目

沅思，與現實隔絕。在最危急時期，病尺每被誤為神經失常而被送入

青山醫院，飽受不必要之痛苦。

戶三）頻頻搖州馬拉松式必電話，動輒數小時，其＞

ssociated

Sym震。日s為．

6onst-

pation。fthe

brain

and

diarrhoea。f

t口e工nouth留、。

八州）衣著講究，細意打扮。男患者之先天性豪曠性格失諸

於無形；女患者ul變得傲慢；此病徵可能與內分泌失調有關。

阿丁徇椅學識有限，所以目前只能約忍將此症區分為急性與頑固

慢性兩大頻。急性者的症微約於二星期至四星期消退，慢性者則可能

拖延數年之次。急性听能引起之併發症較少；頑固慢性則較多。各方

大雅并J=,/a1對此病仔心得或理論，幸不吝賜教不勝感激。

PrintedbyshumshingPr加tingCbl,，州叮Tel.．俘724s1)