ABSTRACT
Surgical pathology is an important ele ment of surgery,as well as the foundation and prop of surgi cal practice.The technical surgeons,who are void of basis knowledge of pathology,may improve their own techniques,but could not enhance the ability of clinical judgement.To eliminate these surgeons' ignorance is better than to improve their surgical techniques.
ABSTRACT
An introduction to the practice of introducing the“ surgeon qualification admittance system”in the hospital and a description of its management framework,basic principles,rules of classification for surgical operations,application and approval procedure,and supportive management regulations.The authors hold that this system has normalized behavior of medical activities,clarified operation authorities of medical doctors at various levels,and intensified the awareness of risk exposure.Therefore this system can safeguard the quality and safety of surgical operations and its efficiency to a great extent,in addition to better building the team and backup forces.
ABSTRACT
Factitious disorder is characterized by physical or psychological symptoms that a person intentionally produces or feigns to pretend to be sick although not for external benefits such as financial compensation. As a result of the difficulty in diagnosing the disorder, its prevalence is relatively rare. The definite diagnosis and its proper management is important, particularly in preventing unneeded medical procedures as well as reducing stress in these patients’ families and reducing cost of management. We report a 17-year-old woman who presented to the Department of Surgery with severe abdominal pain and underwent her 5th abdominal operation due to provisional diagnosis of gut obstruction. The surgeon found only some fibrosis which could not explain her severe abdominal pain. After the operation, she still had abdominal pain, distension and intermittent fever although no source of infection nor physical illness could be found to explain this. Psychiatric consultation was came out because of her disturbed behavior and because she was uncooperative. We found that she had been admitted to several hospitals more than 50 times and had undergone 4 major operations in the past 4 years because of her abdominal pain. Surprisingly she was not distressed at all despite these chronic physical illnesses. After close observation by ward nurses, her persistent fever finally disappeared. We transferred her to our psychiatric ward and gave one of serotonin-specific reuptake inhibitors (SSRIs) which is effective in treating compulsion as well as depression, together with family counseling and individual psychotherapy. Finally she confessed that she feigned the symptoms, so we could make the definite diagnosis of factitious disorder with predominantly physical signs and symptoms.