食管炎误诊食管癌2例分析

食管炎是食管常见疾病 ,其 X线表现易与食管癌混淆。我科曾遇 2例食管炎误诊为食管癌 ,现报告并分析如下。例 1:患者女 ,46岁 ,于 1998年 12月 2 8日就诊。反复呕吐、返酸伴胸骨后闷痛及烧灼痛 10年 ,近 2个月吞咽困难并呕血 1次。查体 :一般情况可 ,T36 .5℃。心肺听诊无异常 ,血常规、血沉正常。X线表现 :食管中下段平第 7胸椎下约 8cm管腔呈轻度向心性狭窄 ,管壁稍僵硬 ,扩张受限 ,边缘欠规整 ,局部粘膜增粗迂曲、紊乱 ,其内可见多个小斑点状龛影 ,钡剂通过可。诊断考虑食管癌。患者曾到上级医院复诊 ,均诊为食管癌。后入本院行手术治…     

食管癌早期影像学诊断及误诊原因研究

目的研究探讨早期食管癌的影像学诊断方法及误诊原因。方法筛选24例影像学检查误诊为早期食管癌的病例，分析早期食管癌的影像学检查方法、征象及造成误诊的原因。结果在早期食管癌的诊断上，细胞学、电子内腔镜、影像学三者是相辅相成的。结论应强调各种检查手段的独立诊断意义，切忌受一种检查手段诊断结论的影响，以免造成误诊。     

误诊为食管癌,贲门癌7例原因分析

1980～1991年,我们将7例患者误诊为食管癌、贲门癌而行手术治疗。现将误诊原因分析如下。1 临床资料 本组男6例,女1例;年龄42～65岁。术前误诊为食管癌2例,贲门癌5例。主要表现为进食阻挡、哽噎。1例行食管癌切除、食管胃弓上吻合术,术后病理证实为食管溃疡伴瘢痕性狭窄。1例行隆突下肿块切除术,病理证实肿块为炎性组织。3例行贲门癌切除、食管胃弓下吻合术,病理证实为返流性食管炎。1例行食管贲门癌切除术,病理证实为食管下端平滑肌瘤。1例行近端胃次全切除、食管胃弓下吻合术,病理证实为胃底多发性溃疡并陈旧性穿孔。2 误诊原因分析2.1 返流性食管炎误诊为贲门癌 本组3例。返流性食管炎主要表现为进食阻挡感、咽下疼痛等。上述症状与食管癌贲门癌极相似,易造成误诊。返流性食管炎狭窄发展慢、病程较长。立位吞钡检查显示食管下端3～8cm不能迅速扩张,活动受限、僵直,此时如改变体位,增加胸腹腔压力差,可观察到     

食管良性疾病误诊为食管贲门癌行外科手术治疗53例分析

1970～ 2 0 0 2年 ,我们曾遇 5 3例食管良性疾病被误诊为食管贲门癌而行外科手术治疗。术后诊断明确 ,其症状均消失或缓解。现报告如下。临床资料 :本组男 3 9例 ,女 14例 ;年龄 3 4～ 70岁 ,平均 5 5岁。其中 ,食管结核 4例 ,食管旁结核性肿大淋巴结压迫食管 12例 ,返流性食管炎 9例 ( 3例合并食管下段溃疡 ) ,食管憩室 10例 ,贲门失弛缓症 4例 ,食管平滑肌瘤 5例 ,食管下段静脉曲张2例 ,肝左叶压迫贲门部 2例 ,主动脉弓压迫食管 5例 ( 1例为右位主动脉弓 )。主要临床表现为吞咽困难 ,咽部紧缩感 ;胸骨后疼痛不适 ,烧灼感 ;胸背部疼痛 ,进…     

老年人食管癌80例临床分析

我科１９８９～１９９８年收治６０岁以上食管癌患者８０例,现就其临床外科情况分析如下。１　临床资料１．１　一般资料　本组８０例患者,年龄６０～７８岁,平均６８．２岁,男性５６例,女性２４例,男女之比为２．３∶１。１．２　症状及有关病史　有不同程度的进行性吞咽困难,咽下时胸骨后不适、烧灼感、异物感７９例（９８．７％）,仅有１例无吞咽困难,偶发胸骨后不适（１２．５％）。伴有慢性支气管炎、肺气肿２７例（３３．７％）,陈旧性肺结核６例（７．５％）,高血压病７例（８．８％）,冠心病１４例（１７．５％）,胃炎…     

食管癌肉瘤三例分析

我院从 1990年 1月至于 1998年 1月共诊治 3例食管癌肉瘤病人 ,从临床表现、 X线钡餐表现、内镜表现、手术标本病理特点并综合文献资料,进行分析报告如下： 　　例 1男, 49岁。吞咽困难 4个月就诊,食管钡餐透视：食管下段不规则充盈缺损,病变以上食管扩张。胃镜：食管距门齿 35～ 38cm后壁球形隆起,表面糜烂周边粘膜粗糙,活检送病理检查,炎性渗出物,坏死组织,少许鳞状细胞癌。术后标本见息肉样肿物,大小约 3cm,亚蒂附着于食管壁;内镜下：肿瘤内纤维肉瘤成份基底见鳞状细胞癌,证实食管癌肉瘤。未经化疗随访 1年无复发。 　　例…     

3例食管癌肉瘤临床分析

10年间在我科检查并经病理证实为食管癌肉瘤的患者共3例,现将诊治体会介绍如下。     

食管癌84例临床分析

目的探讨食管癌的发病因素。方法回顾分析84例食管癌病例的临床资料。结果食管癌的发病与性别、年龄、职业及不良生活习惯有关,男性发病多于女性;发病年龄以高年龄组为主;多发于农民,且与饮酒、吸烟有密切关系。结论应提高对食管癌的早期认识、早期诊断和早期治疗,并尽量减少不良的生活习惯,做好预防工作,以减少食管癌的发生率,提高生活质量和生存率。     

老年肺结核78例误诊分析

老年肺结核临床表现不典型 ,合并症多 ,不易识别 ,误漏诊率高。现将近 10年来我院误诊的 78例老年肺结核分析如下。临床资料1.一般资料78例中男 6 2例 ,女 16例 ;6 0～ 82岁 ,6 0岁～ 80岁 6 9例 ;≥ 80岁 9例。PPD皮试和抗结核抗体阳性者 11例。有低热、盗汗等 34例 ,多数患者有咳嗽、咳痰、纳差、乏力、胸闷或咯血。痰涂片 (含纤维支气管镜刷检 )或结核菌培养阳性者 5 1例 ,诊断性抗结核治疗 2 4例 ,淋巴结穿刺 1例 ,病理证实 2例。2 .误诊的病种肺炎 2 5例 ,支气管扩张及支气管扩张并发感染 2 7例 ,慢性支气管炎及慢性支气管炎并发感染…     

儿童纵隔肿瘤误诊漏诊临床分析

目的探讨误诊漏诊儿童纵隔肿瘤的原因。方法分析我院25例误诊漏诊纵隔肿瘤的患儿临床资料。结果25例误诊漏诊的纵隔肿瘤患儿中,畸胎瘤10例,淋巴瘤7例,神经母细胞瘤4例,胸腺瘤3例,神经纤维瘤1例,大部分患儿因反复咳嗽,喘息,发热就诊而被误诊为肺炎。结论儿童纵隔肿瘤易于误诊的主要原因为其临床表现不典型或被肺炎掩盖以及临床医生对其认识不足或对摄胸部X线片、CT不够重视而被误诊漏诊,因此临床医生要对儿童纵隔肿瘤高度警惕,以便尽早做相应检查以确诊。     

Quality of life measurement in patients with oesophageal cancer.

Quality of life (QOL) measurement may aid decision making in the treatment of patients with oesophageal cancer but must be clinically valid to be useful. This study considered if the European Organisation for Research and Treatment of Cancer QOL questionnaire, the QLQ-C30, showed differing results in two clinically distinct groups of patients with oesophageal cancer and also investigated the correlation between dysphagia grade and various scales of QOL. Patients treated by oesophagectomy reported significantly better physical, emotional, cognitive, and global health scores than those in the palliative treatment group. Patients who received palliative treatment had significantly worse pain, fatigue, appetite loss, constipation, and dysphagia. The correlations between dysphagia grade and each of the QOL scales and items in both groups of patients were poor. This questionnaire differentiates clearly between the two clinically distinct groups of patients, but to be an entirely appropriate indicator of QOL in patients with oesophageal cancer, an additional specific oesophageal module including a dysphagia scale is required.     

主动脉夹层33例误诊漏诊原因分析

目的：进一步提高对主动脉夹层（AD）的认识,减少误诊和漏诊。方法：对我院急诊内科、心内科、胸外科33例曾经误诊为其它疾病的主动脉夹层患者的临床资料进行回顾性分析。结果：33例中被螺旋CT证实16例（48．5％）,磁共振证实10例（30．3％）,彩色多普勒证实10例（30．3％）,l例（3％）来不及检查,尸检证实。AD的临床特点：（1）50岁以上17例（81．8％）;（2）伴高血压病24例（72．7％）,动脉硬化25例（75．8％）;（3）剧烈疼痛：都有剧烈疼痛,其中：胸腹痛29例（87．9％）,腰痛8例（24．2％）;（4）血压脉搏两侧不对称10例（30．3％）,总误诊漏诊33例（100％）,误诊时间（36．0±41．6）h,误诊疾病：心血管病10例（30．3％）,消化系统疾病12例（36．4％）,呼吸系统疾病8例（24．2％）。结论：熟悉主动脉夹层的临床特点,及时采用影像学检查方法,进行综合分析,可避免误诊和漏诊。     

外科手术前患者慢性阻塞性肺疾病患病率及漏诊率调查

目的研究外科手术前患者慢性阻塞性肺疾病(COPD)的患病率、漏诊率以及与高危因素的关系。方法选择2007年11月至12月在复旦大学附属中山医院准备行胸腹部非急诊手术的339例患者,所有患者经肺功能室检查,记录并分析其一般情况、暴露史和肺功能检查结果。结果COPD的患病率21.8%,漏诊率83.8%。53.1%暴露史阳性,吸烟和职业暴露分别为43.1%和18.6%;两类暴露人群的患病率分别为34.2%和36.5%。暴露史阴性受检者的患病率为8.8%,漏诊率为71.4%。在50岁以上的受检者中,暴露史阳性和阴性的患病率分别为38.0%和10.0%。男性患病率为25.1%,高于女性的15.2%(P=0.04),但Logistic回归分析显示患病率同性别无关(OR=0.80,95%CI:0.42～1.51),同暴露史有关(OR=4.22,95%CI:2.35～8.34)。肺癌和非肺癌患者COPD的患病率相似。新检出的的COPD漏诊者中,Ⅰ级30.6%,Ⅱ级56.5%,Ⅲ级11.3%,Ⅳ级1.9%。结论外科患者多数有吸烟和职业暴露等COPD高危因素,长期职业暴露所占比重较大。COPD的患病率高,漏诊现象严重,且病情多已达到或超过中度水平。     

Chronic heart failure in the community: missed diagnosis and missed opportunities

BACKGROUND: The aim of this study was to determine the incidence of congestive heart failure (CHF) in patients discharged from a hospital without a diagnosis of CHF who were admitted with shortness of breath and had a low left ventricular ejection fraction (LVEF). CHF is a devastating disease in terms of financial cost, prevalence, and effect on morbidity and mortality. The true incidence rate is not known because of reliance on discharge records and death certificates, and because diagnosis remains a clinical judgment. METHODS AND RESULTS: CHF was diagnosed by the Framingham criteria. We retrospectively reviewed the records of 225 randomly selected patients admitted with a complaint of shortness of breath and discharged without a diagnosis of CHF (group 1). We compared group 1 with patients admitted at the same time with a diagnosis of CHF and of similar age and LVEF (group 2). In group 1, 100 patients had a low LVEF (< or =40%) and 51% met criteria for CHF that had been missed. Readmission rate was high (42%). Mortality at 12 months was 18%. Rate of cardiomegaly on x-ray films was similar in groups 1 and 2 (64.6% v 64.4%, respectively). Third heart sound (39% v 10%; P <.001) and heart rate > 120 beats/min (41.7% v 12.5%; P <.001) were significantly more frequent in group 1. By contrast, signs and symptoms suggestive of fluid overload were more frequent in group 2. CONCLUSIONS: Many patients admitted with shortness of breath and low LVEF have CHF but are not diagnosed. Physicians are more likely to miss CHF in patients presenting without signs of fluid overload even when third heart sound is present with resting tachycardia. A missed diagnosis of CHF is associated with a high readmission rate, multiple admissions, and a mortality rate comparable to that of patients with newly diagnosed CHF.     

Misdiagnosis in patients with amyotrophic lateral sclerosis

To confirm our impression that a high percentage of patients with amyotrophic lateral sclerosis are initially misdiagnosed, we reviewed records of 33 patients with a definitive diagnosis of amyotrophic lateral sclerosis seen over 10 years. Fourteen patients (43%) were initially misdiagnosed. Mean time to correct diagnosis was significantly greater for the misdiagnosed group (16.0 +/- 9.3 months) than for the rest of the patients (7.6 +/- 4.1 months). Two of three patients with an initial symptom of dyspnea were misdiagnosed. Three patients underwent laminectomies because of misdiagnosis. Age, stage of disease, and unusual presenting symptoms were not identified as causes of misdiagnosis. Most likely causes were physicians' failure to consider the diagnosis and lack of familiarity with the common clinical presentations of amyotrophic lateral sclerosis. Earlier diagnosis of amyotrophic lateral sclerosis may help prevent medical mismanagement and may benefit patients both medically and psychologically.     

Staging in oesophageal cancer

Accurate staging defines groups for stage-specific treatment, minimising inappropriate treatment. Application of dedicated staging methods - including 16-64 multidetector computed tomography (CT), endoscopic ultrasonography with fine-needle aspiration (EUS-FNA) and positron emission tomography (PET) - results in better staging of oesophageal cancer. PET as a metabolic imaging technique that is usually applied after (or recently in combination with) CT (PET/CT) improves the accuracy of non-invasive staging, especially in locally advanced oesophageal cancer patients. Whether EUS-FNA or PET/CT should be performed as a first diagnostic step is still a matter of debate. Fluoro-2-deoxyglucose (FDG) PET is also promising tool in assessing neoadjuvant treatment response. Application of these dedicated staging methods has a learning curve, suggesting a prominent role for centralisation.     

Screening in spouses of colorectal cancer patients: a missed opportunity

Background

Spouses of colorectal cancer (CRC) patients could be at increased risk of developing CRC due to shared lifestyle habits with the patients which is a notable risk factor. This study explores the various issues surrounding CRC screening among these spouses.

Methods

A mixed method study comprising in-depth qualitative semi-structured interviews followed by structured quantitative questionnaire was administered to spouses who accompanied CRC patients during their appointments, from January 2016 to February 2017.

Results

Fifty spouses of CRC patients, median age of 60 (range, 41–82) years, were qualitatively interviewed but 5 of them did not complete the questionnaire. Only 26 (57.8%) of them were current with CRC screening. Data saturation was reached at the 48th participant.Four main themes emerged from the qualitative interviews. These included (i) adequacy of knowledge and attitudes about CRC screening, (ii) suboptimal public health promotion efforts of CRC screening, (iii) barriers of CRC screening, and (iv) need for mutual spousal support.From the questionnaires, spouses who were not current with CRC screening were more likely to report more barriers and have different cues to actions than those who are current. The majority of the spouses demonstrated high levels of knowledge on CRC, understood its severity and their susceptibility.

Conclusion

Spouses exhibit high levels of knowledge and awareness of the implications of CRC. Apart from addressing psychological issues during the acute phases, targeted interventions should be considered to improve their screening rates and to use them as advocates for CRC screening among family and community.

     

COPD并发气胸误诊漏诊分析及防治对策

目的提高对COPD并发气胸的认识。方法回顾性总结最近10年COPD并发自发性气胸误诊、漏诊的原因。结果本组误诊、漏诊21例,误诊为COPD急性发作,哮喘急性发作,冠心病（心肌梗塞、心绞痛）,高血压,肺性脑病。误诊时间0.5-26 h。结论对COPD急性加重期的病人,应该仔细检查气管的位置;认真进行体检,常规做X线胸部检查,必要时胸部CT检查,减少COPD并发气胸的漏诊和误诊。