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Date	Topics	單位	講員
103/03/06	CBD stone management update	GI	陳海雄 醫師
103/03/13	抗藥性包氏不動桿菌介紹與防治 CRAB and infection control	ICU	陳瑞光 醫師
103/03/20	末期病人告知	FM	陳如意 醫師
103/03/27	行醫核心能力的學習與實踐-經驗與分享	GM	北榮 一般內科 楊盈盈 醫師
103/04/03	Guidelines for the treatment of MRSA in Taiwan Clinical Pathological Conference	INF	施正蓮 醫師 曾鈺婷 醫師
103/04/10	Hyponatremia Clinical Pathological Conference	NEPH	許智揚 醫師 黃建維 醫師
103/04/17	EKG finding suggestive of cardiomyopathy: what to look for and what to do next Clinical Pathological Conference	CV	邱寬饒 醫師 王玟樺 醫師
103/04/24	巴金森氏病診斷與治療之新進展	NEURO	李介元 醫師
103/05/01	Tuberculosis	CM	楊志勻 醫師
103/05/08	整合照顧於內科病房之應用	GERI	台大 創傷醫學部 蔡彥彬醫師
103/05/15	Hypoglycemia	META	永康 新陳代謝科 郝立智 醫師
103/05/22	Myelodysplastic syndromes	HEMA	洪英中 醫師
103/05/29	Overview of IgG4-related disease Clinical Pathological Conference	AIR	顏伶容 醫師 王仕凱 醫師
103/06/05	皮膚淋巴癌蕈狀肉芽腫	DERM	洪千惠 醫師
103/06/12	超音波在急重症的應用	ER	林欣陽 醫師
103/06/19	Final examination	內科部	教學部總

The myelodysplastic syndromes (MDS) comprise a heterogeneous group of malignant hematopoietic stem cell disorders characterized by dysplastic and ineffective blood cell production. MDS occurs most commonly in older adults and may occur de novo or arise years after exposure to potentially mutagenic therapy (eg, radiation exposure, chemotherapy). The diagnosis of MDS should be considered in any patient with unexplained cytopenia(s) or monocytosis. Careful inspection of the peripheral blood smear and bone marrow aspirate is necessary to document the requisite dysplastic cytologic features identifiable in any or all of the hematopoietic lineages (table 2). Detection of certain chromosomal abnormalities distinguishes between MDS and acute myeloid leukemia (AML) in some cases, aids in the classification of MDS, and is a major factor in determining prognostic risk group and therapy. The diagnosis of MDS requires both of the following: Otherwise unexplained quantitative changes in one or more of the blood and bone marrow elements (ie, red cells, granulocytes, platelets). The values used to define cytopenia are: hemoglobin <10 g/dL (100 g/L); absolute neutrophil count <1.8 x 109/L (<1800/microL); and platelets <100 x 109/L (<100,000/microL). However, failure to meet the threshold for cytopenia does not exclude the diagnosis of MDS if there is definite morphologic evidence of dysplasia. Morphologic evidence of significant dysplasia (ie, ≥10 percent of erythroid precursors, granulocytes, or megakaryocytes) upon visual inspection of the peripheral blood smear, bone marrow aspirate, and bone marrow biopsy in the absence of other causes of dysplasia (table 2). In the absence of morphologic evidence of dysplasia, a presumptive diagnosis of MDS can be made in patients with otherwise unexplained refractory cytopenia in the presence of certain genetic abnormalities. Importantly, blast forms must account for less than 20 percent of the total cells of the bone marrow aspirate and peripheral blood. In addition, the presence of myeloid sarcoma or certain genetic abnormalities, such as those with t(8;21), inv(16), or t(15;17), are considered diagnostic of acute myeloid leukemia, irrespective of the blast cell count. MDS must be distinguished from other entities that may also present with cytopenias and/or dysplasia. Common conditions that present with features similar to MDS include HIV infection, deficiencies of vitamin B12, folate, or copper, and zinc excess. Other entities considered in a specific case depend largely upon the presenting features. MDS is classified using the WHO classification system based upon a combination of morphology, immunophenotype, genetics, and clinical feature.