降央卓玛
发表于3分钟前回复 :继将好兄弟Wilson的爱车开进旧情人Cuddy的客厅后,备受伤害的House终于在等待假释的看守所内找到了新的刺激。当然,编剧没有忘记为House安插新的小朋友进行调教:这次被House征服的是具有一副混血面孔的美丽女医生Adams。House在新剧集里再次展现了惊人的天赋。过人的观察力、大胆的推理、剑走偏锋的行事风格和神乎其技的查体功底一览无遗。曾在Hopkins训练过的高材生Adams医生态度也从开始的倨傲转向惊奇,并最终成为House式行动的追随者。本集的病例依旧稀有。与往常不同,House这次并没有充沛的医疗资源可加利用,诊断完全依靠最原始的手段。一名年轻男子在狱中相继出现了关节痛、发热、皮疹等症状,Adams起初认为是淋病,但House以更有说服力的红斑狼疮推翻了Adams。不过患者的表现远不止这么简单,该男子被烟草熏黄的手指和接下来发生的骨折使House转向晚期肺癌的诊断。此时的House表现出神乎其技的听诊技能:在没有听诊器的情况下House准确地查出患者肺部存在阴影。有经验的临床专家通过轻拍即可了解患者两肺的情况,更有奇人可仅凭听诊估算患者心脏的EF值(射血分数,通常需要心脏超声的帮助来进行模拟计算)。House的天赋大概集中了全世界最有经验医生的传奇,当然,对于绝大多数中庸之资的凡人来说,追求这种境界其实远不如读好一张胸片或安排一次可靠的超声来的保险。House的神奇并没有帮到这名患者,胸片显示该男子的肺部阴影并非癌症。患者极易流血不止的表现也不符合肺癌晚期常有的高凝状态,病情更趋复杂了。除此之外,患者又发生了过敏性休克,幸好有医生在场,简易情形下的气管切开术挽救了这个年轻人的生命。现在,所有的临床表现终于齐全了:凝血功能障碍、皮疹、骨质疏松、过敏,答案会是什么呢?即将离开的House想到了肥大细胞增多症(Mastocytosis)。这种血液系统疾病能够侵犯全身多个系统,并常常表现为发作性过敏。肥大细胞释放组胺等炎症介质,使得患者产生荨麻疹、喉头水肿甚至窒息。不过,潮红、低血压等类过敏征象并非仅限于肥大细胞增多症,在做出此项诊断之前,还需要谨慎考虑脓毒症、类癌综合征、神经内分泌肿瘤如VIP瘤或嗜铬细胞瘤、甲状腺髓样癌等疾患。而这些疾病的排除需要细致的全身检查和多种实验室检查。House的编剧在此简化了细节,选择利用阿司匹林来进行简易诊断。阿司匹林(乙酰水杨酸)是一种环氧化酶抑制剂,可抑制前列腺素(PG)的生物合成,同时又可促进产生过敏介质白三烯(LT),增强肥大细胞诱发的过敏反应。因此,当已有过敏潜质的患者服用阿司匹林后,很可能当场诱发过敏性休克。这将有助于排除上述其他原因造成的类似表现。晚餐上的纸条证明,House又一次猜中了结局。当然,本剧的亮点远非这个case本身。House在深陷江湖危机之时还不忘为室友拯救中毒的宠物蟋蟀,所用的手段仍然令人耳目一新。而这个成功的解救也为后来House乱中解围埋下了伏笔。House的天赋来自编剧。能够写出各种各样奇怪病例的House编剧,医学功底也相当了得。凑巧的是,在《新英格兰医学杂志》上,就刊有一篇关于肥大细胞增多症的病例报告。在这份报告中,患者在使用阿司匹林后过敏症状加重,麻省总医院(MGH)的现实版House们终于经过周密的诊治手段确认了病情。当然,在鉴别分析及治疗细节上,专业的医学期刊所体现的又是另一种美感了。本集House的故事原型,是否脱胎于此呢?而如此专业的态度,大概也正是国内编剧所无法企及的高度了吧。
王文林
发表于5分钟前回复 :Recipient of the 2007 Golden Globe Award for Best Drama Television Series and multiple Emmy nominations, including Outstanding Drama Series for the past two years, "Grey's Anatomy" returns to the ABC Television Network for its fifth season.Is "happily ever after" possible for Meredith Grey and Derek "McDreamy" Shepherd? With Meredith experiencing a breakthrough in therapy - the realization that she and Derek can be extraordinary together, rather than ordinary apart -- she and Derek now face the highs and lows of being a committed couple.Continuing their first year as residents at Seattle Grace Hospital, Meredith, Cristina Yang, Izzie Stevens and Alex Karev have interns of their own to mentor, including Meredith's half-sister, Lexie Grey. Lexie has become a roommate and confidante to George O'Malley, who, after divorce with Callie, a breakup with Izzie, and learning that he failed his residency test by only one point, is striving to get both his professional and personal life back on track.After attending to his girlfriend Rebecca's mental illness on his own, and revealing that he had gone through this with his own mother, Alex finds solace in Izzie's arms. Alex must continue through this difficult time, whether or not Izzie remains by his side.Cristina, having finally won out over her tough-as-nails mentor, Erica, is back on track as a surgeon - but is there a chance for new love in her life as well?With the encouragement of Mark "McSteamy" Sloan, Dr. Callie Torres has taken a chance on love with cardiothoracic surgeon, Erica Hahn; now, she and Erica must figure out what happens after the first kiss.Overseeing the residents is the no-nonsense Chief Resident, Miranda Bailey. Facing marital troubles and the difficulty of balancing her work and personal life, Bailey has handed her responsibilities as head of the free clinic over to Izzie. Also striving for balance is Chief of Surgery, Richard Webber, who has reunited with his estranged wife, Adele.The doctors of Seattle Grace Hospital deal with life-or-death consequences on a daily basis - it's in one another that they find comfort, friendship and love. Together they're discovering that neither medicine nor relationships can be defined in black and white. Real life only comes in shades of grey."Grey's Anatomy" stars Ellen Pompeo as Meredith Grey, Patrick Dempsey as Derek Shepherd, Sandra Oh as Cristina Yang, Katherine Heigl as Isobel "Izzie" Stevens, Justin Chambers as Alex Karev, T.R. Knight as George O'Malley, Chandra Wilson as Miranda Bailey, James Pickens, Jr. as Richard Webber, Sara Ramirez as Callie Torres, Eric Dane as Mark Sloan, Chyler Leigh as Lexie Grey, and Brooke Smith as Erica Hahn.