All I encounter everyday is infinte stupidity of the inferior majority. Patients are always stupid. Nurses are usually stupid. Residents are often stupid. Attendings are sometimes stupid. They really make me insane. Insane.
The formula to measure the stupidity:
Creativity + Knowledge - Ignorance = Stupidity
真的不懂，為何要聽命服從比我愚蠢的傢伙，做一些毫無成長的雜事？
他們既不會預視到未來的發展，也搞不懂世界的運行。純粹因為他比我老一些？
DIAGNOSIS OF HCC
1. A patient with underlying liver disease (ie, cirrhosis, chronic viral hepatitis)
2. A rising serum alfa-fetoprotein (AFP) level
3. A lesion which is hypervascular, has increased T2 signal intensity, or demonstrates venous invasiona in CT scan of the liver and/or magnetic resonance imaging (MRI)
If the diagnostic imaging studies are less definitive, follow-up imaging may clarify the diagnosis; dysplastic nodules typically remain stable, while an enlarging dominant lesion more likely represents a HCC. Even stable nodules require close follow-up, since livers containing dysplastic nodules are at high risk to develop HCC in the future [29]. Molecular genetic studies have shown promise in identifying a molecular signature that can differentiate dysplastic nodules from HCC, but more studies are needed [30].
For non-cirrhotic patients, the diagnosis of HCC should be considered for any hepatic mass that is not clearly a hemangioma or focal nodular hyperplasia, especially if it is hypervascular. In the absence of specific clues to the diagnosis, biopsy may be appropriate.
2. A rising serum alfa-fetoprotein (AFP) level
3. A lesion which is hypervascular, has increased T2 signal intensity, or demonstrates venous invasiona in CT scan of the liver and/or magnetic resonance imaging (MRI)
If the diagnostic imaging studies are less definitive, follow-up imaging may clarify the diagnosis; dysplastic nodules typically remain stable, while an enlarging dominant lesion more likely represents a HCC. Even stable nodules require close follow-up, since livers containing dysplastic nodules are at high risk to develop HCC in the future [29]. Molecular genetic studies have shown promise in identifying a molecular signature that can differentiate dysplastic nodules from HCC, but more studies are needed [30].
For non-cirrhotic patients, the diagnosis of HCC should be considered for any hepatic mass that is not clearly a hemangioma or focal nodular hyperplasia, especially if it is hypervascular. In the absence of specific clues to the diagnosis, biopsy may be appropriate.
Choice
We thought we could be decent men in an indecent time... but we were
wrong! The world is cruel. And the only morality in a cruel world is chance.
wrong! The world is cruel. And the only morality in a cruel world is chance.
