喉结核误诊13例

目的对喉结核的误诊情况进行分析，明确喉结核的临床表现及诊断要点。方法回顾性分析1996年3月至2003年2月我科误诊的13例喉结核患者临床资料，分析其发病情况、具体临床表现、误诊情况及确诊方法。结果喉结核临床症状大多轻微，缺乏特征表现，多数误诊为急性喉炎或肿瘤。结论为提高诊断率，应尽早行局部病检、X线胸片、痰液涂片检查，且应以病理检查为确诊依据。     

喉结核13例临床分析

喉结核在临床上并不多见,大多数继发于肺结核〔1〕。喉结核早期症状及专科体检表现多不典型,极易误诊、漏诊,特别是不伴有肺结核者〔2〕。笔者对本科自2002年至2009年13例诊断为喉结核患者的临床资料进行分析,以提高临床医生对喉结核的认识,减少误诊、漏诊。     

喉结核34例病例报告及治疗前后患者睡眠状况调查

目的:探讨结核的临床特征、诊断及转归情况,监测患者的睡眠状况,减少喉结核的误诊误治。方法:2013—2017年天津医科大学一中心临床学院收治的喉结核患者34例,经组织病理学检查确诊或是规律抗结核药物治疗有明显效果的为喉结核患者的临床资料,监测患者睡眠质量,并分析睡眠质量对患者病程和预后影响。结果:喉结核的主要症状为声嘶、喉痛,多数伴有肺结核。喉镜检查总结为3种类型:水肿型,增生型和溃疡渗出型。经过治疗干预后,患者睡眠质量明显改善。结论:掌握喉结核的临床特点,实现早期诊治并进行睡眠干预,可有效果提高疗效,改善患者睡眠质量,减少感染扩散。     

喉结核16例临床分析

目的总结喉结核的临床特点,探讨喉结核误诊误治原因及防范对策。方法对2001年2月—2016年1月在海军总医院全军耳鼻咽喉头颈外科中心住院诊断为喉结核16例的临床资料进行回顾性分析。结果本组平均年龄49.1岁。14例(87.50%)以声音嘶哑为主要症状,2例(12.50%)以咽痛为主要症状。9例(56.25%)首诊误诊,其中4例误诊为早期声门型喉癌行支撑喉镜下激光辅助肿物切除术,2例分别误诊为任克间隙水肿和声带息肉,行手术治疗,此6例均经术后病理检查证实为喉结核;1例误诊为喉乳头状瘤,1例误诊为喉肿物,均经活组织病理检查证实为喉结核;1例外院病理检查误诊为喉癌转至我院,入我院后经胸部X线及气管镜检查确诊为喉结核。误诊时间平均9.56 d。本组经病理检查确诊9例(56.25%),结合病史、喉部表现、胸部X线及细菌学检测确诊7例。本组确诊后均转至传染病医院进行抗结核治疗,12例治疗1~3个月喉部病变消失,4例失访。结论喉结核临床表现缺乏特异性,易误诊。耳鼻喉科医生应提高对喉结核的警惕性,胸部X线检查应常规进行,对于喉镜下发现的增生型病变应及时行病理组织学检查,对于病理检查不能确诊但高度可疑病例可给予诊断性治疗。     

36例喉结核临床诊治分析

目的探讨喉结核临床表现及误诊原因。方法回顾性分析36例经组织病理确诊喉结核患者的临床资料。结果声音嘶哑、喉痛为喉结核主要症状;喉镜显示病变主要累及声带、室带、环后区;病变形态以肉芽样或结节样增殖性病变为主。经系统抗结核治疗1a,33例治愈,2例失访,1例复发。结论喉结核全身及局部症状不典型,喉镜检查、痰涂片及结核菌素纯蛋白衍化物试验等有助于诊断,确诊依据组织病理检查,规范抗结核药物治疗效果良好。     

原发性喉结核误诊8例分析

目的：分析喉结核误诊原因,提高确诊率。方法：回顾8例原发性喉结核病例的临床资料,分析误诊原因。结果：首诊有7例患者误诊为喉炎,1例误诊为喉肿瘤。结论：对喉结核临床特点缺乏足够认识,基层医院缺乏必要的医技检查,是误诊的主要原因。     

喉结核误诊分析

目的：分析喉结核临床误诊的原因。方法：对21例喉结核临床资料进行回顾性分析。结果：21例喉结核误诊11例，误诊率为52．4％。误诊的原因主要是喉结核临床表现不典型，医生缺乏对本病的认识。结论：医生应提高对喉结核的认识，对可疑的病例尽早行病理检查，减少误诊。     

不典型喉结核14例临床分析

目的 :对不典型喉结核的临床资料进行分析 ,借以探讨近年来不典型喉结核的临床特征 ,提高临床医生对本病的认识 ,避免误诊误治。方法 :采用日本生产Olympus纤维喉镜对喉部进行常规检查 ,并根据需要进行活检或刷检。结果 :所有病例均经病理证实为结核。结论 :对可疑喉结核的病例应尽早行纤维喉镜检查 ,并在镜下取活检 ,做病理诊断 ,这是确诊喉结核的主要方法     

原发性喉结核12例误诊分析

近年来随着结核病发病率的逐年上升，喉结核也多了起来，原发性喉结核又因其缺乏特征性的症状和体征，易于各种喉部疾病相混淆导致误诊误治。现将近我科收治外院误诊的原发性喉结核12例做总结分析，探讨如何尽早诊治原发性喉结核。     

老年肺外结核误诊71例分析

目的：总结老年肺外结核误诊原因及教训。方法：对71例老年肺外结核误诊情况进行分析。结果：肺外结核误诊主要疾病为淋巴结结核，肠结核、结核性腹膜炎，肾结核，椎体及骨关节结核，喉结核误诊。因患者、医生或医患双方共同造成延误诊断。结论：肺外结核误诊主要原因是临床表现多样，体检和无创性检查乖法诊断，医生专业知识欠缺及用药方法欠规则。     

近年喉结核的临床病理特征

目的探讨近年喉结核的临床病理特征。方法回顾性分析48例喉结核患者的临床病理资料。结果患者以男性多见,男女之比为2.2∶1,中位年龄46.5岁。患者均因喉部症状就诊,声嘶为最常见症状,肺部症状及全身症状少。发病部位以声带最常见(64.6%),其次是会厌(31.3%)和室带(25.0%)。肉眼病变以肥厚性或外生性为主,溃疡性病变多发生在会厌和杓区。组织学病变以增生为主型多见(87.5%),坏死为主型及混合型少见。多数标本含菌量较少,菌体多分布于肉芽肿的类上皮细胞及多核巨细胞的胞质内。结论近年喉结核临床表现多不典型,其感染途径可能已发生改变。临床医师对非特异性喉部病变进行诊断时应考虑到喉结核的可能性,显微镜下应注意该病与喉部其他肉芽肿性疾病的鉴别。     

住院结核病患者佩戴口罩现状调查

目的:对住院结核病患者佩戴口罩的比例、口罩种类和来源进行调查,以探讨有效的管理方法。方法:自行设计问卷,对14个省、市20家医院的结核病房护士长或医院护理部主任进行调查。结果:调查范围共涵盖32个病区,其中15个(46.9%)病区患者不佩戴口罩,16个(50.0%)病区部分患者佩戴口罩,1个(3.1%)病区所有患者均佩戴口罩;84.4%的病区患者佩戴普通一次性口罩和纱布口罩,15.6%的病区患者佩戴外科口罩;53.1%的病区口罩由患者自己随意购买;46.9%的病区免费或收费为患者提供;综合医院结核病区为患者提供口罩的比例和患者佩戴率均高于结核病专科医院,差异有统计学意义;为患者提供口罩的病区和患者自己购买口罩病区患者佩戴率没有统计学差异。结论:目前国内医院对肺结核患者佩戴口罩的管理欠规范,佩戴比例较低,口罩种类不尽合理。提示结核病医院应加强对患者佩戴口罩行为的干预管理,降低医院感染风险。     

SUBGLOTTIC STENOSIS SECONDARY TO TUBERCULOSIS

Although the incidence of laryngeal tuberculosis has been declining over the past 30 years, it should still be considered in the differential diagnosis of patients with laryngeal pathology. In contrast to the pre-chemotherapy era, few, if any, signs of pulmonary tuberculosis are seen in such cases, and presentation is similar to either chronic non-specific laryngitis or carcinoma. The subglottis is a site rarely involved in laryngeal tuberculosis. Tissue biopsy and culture are diagnostic and a full course of antituberculous chemotherapy usually resolves the condition. Airway insufficiency due to fibrosis, however, often necessitates surgical Intervention. We present a case where the only laryngeal manifestation of tuberculosis was subglottic stenosis.     

Analysis and Optimization of a Regional Blood Bank Distribution Process: II. Derivation and Use of a Method for Evaluating Hospital Management Procedures

The practice of allowing participating hospitals in a regional blood bank system to return unneeded blood units to the central bank for redistribution (recycling) makes it difficult to account for each hospital's role in the production of outdates. The usual blood management efficiency criterion of measuring the rate of outdating occurring at a particular hospital has limited meaning when there is recycling because some hospitals avoid high outdate rates by "dumping" their old units on the central bank, while other hospitals have high outdate rates, because they receive disproportionately large numbers of old blood units which have been returned by other hospitals. By using data from a one-year period at Milwaukee Blood Center, a new blood management efficiency criterion, effective outdate rate, is derived with the use of basic Markovian principles. This is the rate at which a hospital contributes to outdates anywhere in the regional system. The rate for each hospital may be compared to evaluate the relative performance of that hospital. The rate is also converted to a "cost of transfusion" to give a direct "dollar" method for informing hospital blood bank managers of their performance.     

Analysis of tuberculosis mortality in a general hospital of a large city

In thanatogenesis of tuberculosis in emergency cases admitted to general hospitals in 1998-2000 predominated acute destructive prigressive forms which are most unfavourable epidemiologically. At autopsies tuberculosis is encountered 3 times more frequently. The diagnosis of tuberculosis is missed because of critical condition of the patients and their short stay in hospital due to early lethal outcome which doesn't allow adequate examination for tuberculosis.     

A study of long-term oxygen therapy in Japan and other Asian countries.

In order to investigate the use of long-term oxygen therapy in Japan, I sent questionnaires to the national chronic disease hospitals and general hospitals that are known to frequently treat respiratory diseases. I found that 61% of the chronic disease hospitals that responded had patients receiving long-term oxygen therapy in the hospital, and 12% had patients receiving it at home. Of the general hospitals answering the questionnaire, 77% had inpatients on long-term oxygen and 39% had home patients receiving oxygen therapy. The majority of patients were on oxygen for treatment of tuberculosis, its sequelae, or obstructive lung diseases. The mean PaO2 for inpatients and outpatients on oxygen was 69 mm Hg and 65 mm Hg, respectively. The cannula is the most frequently used oxygen delivery appliance. Hospital piping systems are used for inpatients, and cylinders and concentrators are used by outpatients. Health insurance covers the cost of oxygen and equipment for hospitalized patients. Home oxygen and equipment are paid for by the patient himself, or at public expense. According to the results of my questionnaire, in Hong Kong long-term oxygen is administered in the hospital only. In Korea it is administered in the hospital and on rare occasion in the home. In Taiwan oxygen is not administered on a long-term basis.     

Errors in the diagnosis of tuberculosis in general hospitals]

Ninety-six lethal cases of tuberculosis overlooked in general hospitals of Minsk in 1983-1989 have been analyzed clinicopathologically. The examination in general hospitals provided intravital diagnosis of tuberculosis in 18% of the cases only. The largest proportion of the overlooked cases related to disseminated tuberculosis (69.0 +/- 4.7%). Extrapulmonary tuberculosis and caseous pneumonia are also often missed in general institutions. Low detection of tuberculosis is attributed to incompetence of the internists in reading roentgenograms, inadequate phthisiatric alarm, incomplete x-ray and bacteriological examinations, especially of patients at risk for tuberculosis.     

动态CT增强对肺内多发球形结核的诊断

目的评价CT动态增强扫描对肺内多发球形结核的诊断及鉴别价值.方法对13例共31个肺内多发球形结核分别进行CT平扫及增强的前瞻性对比研究.结果球形结核的最大增强CT值为4.0±2.4HU,增强前后多发球形结核强化不明显.增强后的形态学特征表现为球形结核无任何强化26个(83.9%,26/31),呈包膜样强化5个(16.1%,5/31).CT平扫诊断正确率为23.1%(3/13),增强后诊断正确率为100%(13/13).结论对肺内多发结节进行CT动态增强扫描有助于多发球形结核的鉴别诊断.结节无强化或有包膜样强化是诊断结核的影像学依据.     

SANTA vs. public tuberculosis hospitals: the patient experience in the Free State, 2001/2002

This paper reflects on the appropriateness of the decision to close down a non-governmental organisation (NGO), state-aided tuberculosis (TB) hospital in the Free State in 2003. Henceforth hospitalisation of TB patients would take place at public district hospitals. A survey conducted late-2001/early-2002 revealed a more positive patient experience of hospitalisation for TB in public hospitals than in the NGO hospital. Consideration of the patient experience serves to inform the debate concerning continued outsourcing of TB hospital care to NGOs in South Africa. This study discusses comparative findings in respect of patients' biographic and socio-economic characteristics, health beliefs, satisfaction with hospitalisation, experience of stigmatisation, adherence to treatment and absconding from hospital.     

The impact of environmental cleanliness on infection rates

Much has been said in recent years about the lack of environmental cleanliness in hospitals. The House of Lords Select Committee (1998) talked about falling standards in hospital cleaning and, more recently, the government acknowledged in The NHS Plan (Department of Health, 2000) that hospitals were unacceptably dirty. Such comments may affect people's perceptions of hospitals and, rather than regarding them as safe environments that promote healing, they may be viewed as dangerous places that might cause vulnerable patients greater harm. While it is known that about 10 per cent of hospital inpatients have a nosocomial infection at any one time (Emmerson et al, 1996), there is uncertainty about whether there is a sound evidence base to support the theory that dirty hospitals cause infection.