细胞核分裂象在肿瘤病理诊断中的作用

细胞核分裂象(MF)在肿瘤病理诊断中的作用十分重要，它是区别肿瘤良恶性及评估恶性肿瘤分化程度和预后的有效指标。但在临床病理诊断中存在将生理性(再生修复性、功能性)MF混为肿瘤性MF的现象，以及在不同肿瘤中因MF诊断指标与意义不够一致造成误诊。为此对生理性与肿瘤性MF的区别，以及MF在肿瘤诊断中的作用进行讨论。     

超声诊断急性阑尾炎50例分析

目的：分析超声诊断急性阑尾炎的误诊原因，旨在进一步提高急性阑尾炎的诊断水平。方法：总结分析我院2004—06以来，50例经临床诊断．手术及病理证实的急性阑尾炎的超声检查结果，重点讨论各型阑尾炎的超声表现及误诊原因。结果：50例超声检查急性阑尾炎的患者，均经手术及病理证实。急性单纯性阑尾炎5例，B超诊断符合4例，误诊为化脓性阑尾炎1例；急性化脓性阑尾炎27例，B超诊断符合27例；坏疽性阑尾炎11例，伴穿孔2例，B超诊断符合7例，误诊为化脓性阑尾炎4例；阑尾周围脓肿7例，B超诊断符合5例，误诊2例，其中1例误诊为右侧卵巢巧克力囊肿，1例误诊为结肠肿瘤。结论：超声检查在临床诊断急性阑尾炎及其他急腹症的鉴别诊断中具有重要作用，并可为阑尾炎的分型提供参考依据。     

术中冰冻快速诊断的临床病理漏误诊原因分析

冰冻快速诊断在手术中对判断肿瘤的良恶性已起到积极甚至是关键的作用 ,这已是不争的事实 ,但术中冰冻切片诊断的难度也是众所周知的。从文献报道看 ,冰冻切片与石蜡切片的诊断符合率可达 93%～ 99 0 5 % [1] 。本文重点分析漏误诊的原因 ,并找出了影响冰冻切片漏误诊的关键环节。1　加强临床病理联系的必要性病理诊断是定性诊断 ,之所以具有权威性 ,因为它是终结诊断 (ＣＴ、Ｂ超、ＭＲＩ、核素等都是定位诊断 )。但临床医师在冰冻诊断中的作用也不可忽视 ,他们的手术所见相当于病理医师的大体观察 ,这也是《手术中病理诊断》一书的主编陈…     

子宫肌瘤B超漏、误诊原因分析

目的 探讨子宫肌瘤B超漏、误诊的原因。方法 回顾性分析676例疑为“子宫肌瘤”而手术患者的术前超声诊断，并与病理结果对照。结果 超声检出子宫肌瘤648例，检出率95.9%(648/676)；术后病理确诊为子宫肌瘤650例；超声诊断与病理符合533例；漏误诊143例。漏误诊率21.2%(143/676)。肌瘤误诊为其它疾病89例，其它疾病误诊为肌瘤26例，漏诊28全郇常见的误诊是子宫腺肌症，其次是附件，内膜疾病等。结论 造成子宫肌瘤漏误诊原因是部分子宫肌瘤声像图无特异性及未重视病史等。     

宫外孕138例超声诊断及误诊原因分析

目的：探讨提高超声对宫外孕的诊断及减少误诊。方法：选择2004／2007年在我院行B超检查诊断为宫外孕的138例患者与其手术病理结果对照，就其声像图特点及误诊原因进行分析。结果：138例患者与其手术病理结果对照，宫外孕132例，宫外孕误诊为其他疾病5例，其他疾病误诊为宫外孕6例。结论：超声对于多数具有特征性声像表现的宫外孕诊断并不困难，但应于其他相似回声病变鉴别，以此减少误诊，提高诊断准确率。     

涎腺恶性淋巴上皮病变的病理分析

恶性淋巴上皮病变是一种发生于涎腺的罕见恶性肿瘤。涎腺淋巴上皮病变的病因尚不清楚，在临床上容易误诊为“混合瘤”，在组织病理方面，低度恶性的淋巴上皮病变容易与良性淋巴上皮病变相混淆，造成误诊。现将我院病理科遇到的4例报告如下，通过病理形态的观察，对其病因组织来源、诊断、鉴别诊断进行探讨。     

肝脏超声造影误诊62例分析

目的探讨肝脏病变超声造影的误诊原因,提高正确诊断率。方法收集有病理诊断的肝脏超声造影资料,将其中与病理诊断不符的62例进行回顾性分析。结果 26例超声造影诊断为肝癌,病理诊断为良性病变;19例超声造影诊断为肝内良性病变,病理诊断为肝细胞癌;15例肝脓肿与肝内胆管细胞癌、肝细胞癌的相互误诊;2例肝血管瘤误诊为肝增生病变。结论超声造影的误诊原因是因不同病变的增强模式相似而导致鉴别诊断失误,密切结合临床,仔细辨析造影图像,是减少误诊的重要环节。     

妇科疾病B超检查误诊漏诊常见原因(附685例分析)

目的探讨超声检查对妇科疾病的诊断价值 ,分析误诊、漏诊原因。方法应用B超检查追踪卡对 685例妇科疾病的B超诊断与手术病理结果对照分析。结果B超诊断与病理诊断符合率 75 2 %( 5 15 / 685 ) ,误诊率 18 7%( 12 8/ 685 ) ,漏诊率 6 1%( 4 2 / 685 )。结论B超检查在妇科疾病的诊断中起重要的作用 ,但要掌握不同病变的声像特点 ,减少误诊漏诊率     

常规超声及超声造影在不同类型子宫肌瘤诊断中的误诊原因分析

目的探讨常规超声与超声造影在不同类型子宫肌瘤诊断中的误诊原因。方法与病理诊断结果对照，对56例不同类型子宫肌瘤患者的常规超声、超声造影及临床病理资料进行回顾性分析。结果56例子宫肌瘤常规超声诊断41例（73．21％），误诊15例（26．79％）；常规超声误诊的主要为原因主要为肌瘤表现不典型，未见明显肌瘤边界，CDFI未探及环状、半环状血流信号或未探及蒂部血流及同侧卵巢。超声造影诊断53例（94．64％），误诊3例（5．36％）。56例中常规超声误诊率明显高于超声造影（P〈0．05）。结论分析常规超声及超声造影误诊原因，有利于提高超声对不典型子宫肌瘤术前诊断的准确率。     

经阴道超声诊断宫颈病变—附124例病理对照分析

目的 探讨宫颈病变的声像图特征并与病理对照，以提高诊断的符合率。方法 对124例宫颈病变经阴道超声检查并与病理对照，分析误诊原因。结果 宫颈良性病变的诊断符合率86．67％（66／73），宫颈囊肿、宫颈肌瘤、宫颈肥大声像特征明显，诊断符合率较高；宫颈恶性病变诊断符合率92．16％（47／51），且可提示宫颈周围的浸润程度。误诊原因影响诊断正确率。结论 经阴道超声检查诊断宫颈病变，可为临床提供可靠的诊断依据。     

必须明确实验诊断学定位

本文通过实验诊断学溯源、实验诊断学现状与展望、实验诊断学的作用、实验诊断学与检验医学和临床医学的关系等四个问题的论述，讨论了实验诊断学的定位问题。认为，实验诊断学是一门建立在基础医学之上，又以检验医学为基础耳匣务于临床，与各学科各专业多方关联，与临床医学相互依赖、不可分割且不可相互替代的，有发展潜力和发展前途，至关重要的独立学科。提出，必须清楚地明确实验诊断学定位，教好、学好和用好实验诊断学十分重要。     

Eine Analyse von klinisch-manualmedizinischen Untersuchungstechniken am Bewegungsapparat

Clinical examination of the musculoskeletal system, and in particular the spine, consists principally in testing normal functions in order to establish the malfunctions typical of a pathologic condition in their characteristic combinations. The conditions needed for this and the possible ways of achieving it are listed and discussed. It is obvious that clinical examination is still indispensable, especially in nonspecific disorders. Manual medicine techniques have a prominent role in clinical examination. Their development has added a great deal to the diagnostic strategies taught in orthodox medicine, which in fact are given too little attention in orthodox medical training. The aim of the clinical diagnostic procedures applied is to combine topographic diagnosis (site of pain), structural analysis (main structure/s disturbed and nature of the impairment), and the ‘present relevance’ diagnosis (referred pain, symptom cluster).     

百草枯中毒死亡的临床病理分析

目的分析百草枯中毒死亡的临床及病理学特点,探讨百草枯中毒致肺纤维化的损伤机制。方法对2010年1月一2013年12月涉及百草枯中毒的3例死亡案例进行回顾性分析,观察对比急慢性百草枯中毒死亡的临床特点及病理学改变。结果百草枯中毒的临床及病理表现主要是以肺为靶器官的多器官损伤,急性中毒死亡者肺损伤主要为肺水肿及肺透明膜形成,慢性中毒死亡者肺损伤主要为肺透明膜形成及广泛肺间质纤维化。结论临床上应加深百草枯中毒表现及损伤机制的认识以对患者进行早期诊治。而法医学鉴定应结合案情、临床资料、毒物分析及解剖结果进行综合分析而得出正确的鉴定结论。     

From bench to bedside--the impact of the transfer of the new biology to clinical medicine

Recent advances in cellular and molecular biology have enormous implications for clinical medicine. Of particular interest is the ability to diagnose genetic diseases. Although enormous advances have been made in the diagnosis of monogenic disorders, these diseases account for a relatively small percentage of patients seen in adult medicine. Of more interest in terms of clinical impact are the chronic diseases with a genetic component which occur in about 10% of the population e.g. diabetes mellitus, heart disease, malignancy. If a subgroup of patients with a chronic disease such as diabetes mellitus, who are at particular risk to develop complications, can be identified, the physician will have to convince them to alter their lifestyle. The transfer of basic science to clinical medicine may ultimately lead to a greater emphasis on the art of medicine.     

Decision-making in a physician's practice

The article covers modern principles of the decision-making method, used in medicine and gastroenterology, in particular. These principles are based upon taking into consideration psychosocial features of a doctor and a patient, types of doctor's thinking and pathologic processes, as well as the effect of a range of negative factors, such as conformism, engageness of a doctor, neurotism etc. The author pioneers the treatment of decision-making in medicine.     

形神统一理论下的宫颈癌诊疗流程

形神理论作为中医学基础理论的一部分,在中医诊疗的临床工作中被广泛应用,并且已经在恶性肿瘤中医治疗中起到指导作用。该文通过阐明恶性肿瘤中形神医学的基本概念并将其细化到宫颈癌的诊治中,探讨了在宫颈癌中形神损伤的评价与治疗、不同阶段形神的治疗重点及所要达到的形神统一的目标,尝试建立形神统一理论下的宫颈癌诊治流程,希望发挥中医学整体观念的优势,为形神理论指导下的宫颈癌中医治疗提供快捷的流程,提高中医在宫颈癌治疗中的参与度,更好地提高中西医结合治疗宫颈癌的临床疗效。     

基因检测在冠心病精准医疗中的应用进展

精准医疗是在诊疗过程中充分考虑患者个体在基因、环境、生活方式等方面差异的医学手段,基因检测是实现精准医疗的重要方式.自人类基因组数据成功解析以来,人们对遗传因素在心血管疾病发生、发展和转归中的作用有了更深刻的认识.迅速崛起的精准医疗围绕心血管疾病的预防和治疗,将基础医学、临床医学和转化医学有机结合,不仅推动了心血管疾病...     

Die k?rpereigene Schmerzhemmung

This article describes the role of endogenous pain inhibition as described for basic research especially in animal experiments. It also considers the results of human experiments and the possibility of a translation of results from animal experiments to pain analysis in humans. Based on the rules of translational research an attempt has been made to utilize the clinically relevant phenomena observed in pain disorders for diagnosis and therapy as described for modern clinical pain assessment. Particular attention is paid to GABAergic and glycinergic inhibition and the approach of manual medicine to these, as well as opioidergic and serotoninergic inhibition in a psychosocial context. This is followed by an extensive interpretation of neurophysiological mechanisms with respect to real clinical symptoms, which are characterized by the loss of inhibitory capacity and appear as distinguishable clinical pain symptoms.     

医学参考系统在我国IVD企业的应用与思考

基于量值溯源的参考系统是检验医学领域重要的研究课题,也是体外诊断产品(IVD)企业提升产品质量和影响力的重要研究方向.检测结果 的准确性和可靠性是临床科学诊断、治疗、预防疾病的重要保障.文章从IVD企业的角度对医学参考系统的基础情况和分类进行简要的阐述,从参考测量程序、参考物质、一致化研究3个方面介绍了参考系统在中国I...     

Ethik-Charta der Deutschen Gesellschaft zum Studium des Schmerzes (DGSS)

The German Society for the Study of Pain has formed an interdisciplinary committee to answer urgent ethical questions on the diagnosis and treatment of pain and to give an ethical orientation on the care of pain and palliative patients. The treatment of pain is a fundamental objective of medicine. Competent and adequate relief of pain in all stages of life is a basic characteristic of a humane medicine oriented to the quality and meaning of life for people. However, there are substantial deficits in all areas, especially in the knowledge of physicians and patients, in training and further education, diagnosis and therapy. Freedom from pain is a substantial element of quality of life. A central duty of all physicians is an adequate diagnosis and treatment of acute pain and thereby the prophylaxis of chronic pain. If pain persists over a longer period of time, it loses the warning function and becomes taken for granted. Alterations, disabilities and limitations of the physical, psychic and social levels are the consequences. For these patients an interdisciplinary approach is necessary by which various medical disciplines, psychologists and physiotherapists are involved and all collaborate on the diagnosis and therapy of pain. All patients have the right to sufficient and individually tailored treatment of pain. Special attention must be paid to vulnerable patient groups, such as newborns, children and adolescents, as well as aged and mentally retarded patients. For cancer patients pain relief of their tumor pain is totally in the forefront. Indications of "unbearable pain" must not lead to resignation or even be seen as an argument for legalization of "death on request". The nursing of terminally ill patients necessitates a special measure not only of clinical, but also ethical competence, communication and multiprofessional collaboration. The modern options for palliative care are real alternatives to demands for legalization of "death on request". Physician-assisted suicide does not belong to the scope of functions of palliative medicine. The basic constitutional law makes an appropriate treatment of pain obligatory. Neglect of pain treatment fulfils the elements of criminal bodily harm. As a consequence, there is a legal right to a comprehensive pain diagnosis and a pain treatment corresponding to the appropriate standard. The state is obliged to provide the legal, social and financial prerequisites for an adequate treatment of pain. Continuous efforts in research are necessary to fill the existing gaps in our knowledge. The transfer between basic research and clinical application of pain therapy must be urgently improved. Of central importance for the German Pain Society are therefore: Improvement of training and further education in pain therapy. Chronic pain must be accepted and coded as an autonomous sickness. Graded structures for care of pain patients must be realized. Interdisciplinary structures of care must be made available to patients with chronic pain. Palliative medical care is a basic right of all terminally ill patients. Politics and health care providers must establish prerequisites for adequate pain diagnosis, pain therapy and palliative medicine.