The aortico-left ventricular tunnel (ALVT) is a rare abnormal channel that arises from the right coronary sinus through the right ventricular outflow tract to enter the left ventricle below the ...aortic valve. The unique ability of multislice computed tomography (CT), as applied in the virtual coloscopy, has not been well established in patients with cardiovascular diseases. We herein investigate the virtual intraluminal image in a patient with an ALVT. An 18-year-old male was admitted with a 6-month-long history of progressive exertional dyspnea. He was diagnosed to suffer from ALVT at 5 months of age and received prosthetic patch closure of the aortic opening of the tunnel with mild residual aortic regurgitation. On admission this time, physical examination revealed a grade 3/6 diastolic murmur over the right upper sternal border. A 16-row multislice CT angiography demonstrated an ALVT. In the 3D reconstructed images, the orifice and intraluminal structure of ALVT were clearly visualized at different levels, similar to a real intracardiac endoscopic images. The patient was then referred for aortic valve replacement due to heart failure caused by severe degenerative aortic insufficiency. Our case displayed successfully not only the entire location of ALVT but also demonstrated the virtual intraluminal imaging mimicking endoscopy. This technique provides the virtual visualization of the entire inner image of AVLT, which may not be possible with other imaging modalities.
本文的研究目的為了解開方醫師對老年用藥的知識及態度。本研究於2007年10月至2008年12月間，針對參與「老年用藥安全門診」研究的開方醫師（139名）進行問卷調查。內容包括老年處方相關問題之態度及知識與老年處方行為自評。134位同意受訪，共完成有效問卷98份，完成率為73.1%。受訪醫師中，僅有9位（9.3%）醫師過去三年中曾接受超過五小時的老人用藥教育，也僅有21.6%的受訪醫師知道有「Beers老年潛在性不適當用藥指南」。但大部分的醫師（93.9%）表示有相關課程願意接受訓練。大部分的受訪醫師執行臨床工作時能大致遵行老人處方開立準則。具有老年醫學專科的受訪醫師較其他專科醫師會使用較低的起始劑量（93.8% vs 64.6%, p=0.02）。老年專科醫師（87% vs 57%, p=0.04）有更高的比例會替老年病患評估有無增加新藥的適應症。國內老年醫學相關教育資源仍不足，加強老年用藥相關教育是重要的。
