The value of screening for autoantibodies in patients with non-specific symptoms

An autoantibody screen is often requested in patients with non-specific symptoms such as pyrexia of unknown origin. However, in a survey of 100 consecutive requests for this investigation in such patients only one patient was encountered in whom the investigation led to a positive diagnosis at an estimated cost of pound 2500. These requests accounted for 5% of the total workload. These observations reaffirm that this should remain a second line investigation and should be deferred until more likely diagnoses have been excluded.     

腹腔镜技术对不明原因腹水的诊断价值

①目的 探讨诊断性腹腔镜技术对不明原因腹水的诊断价值。②方法 对56例经多种影像学检查难以明确病因的腹水病人行诊断性腹腔镜检查。③结果 腹腔镜检查病人无手术并发症，52例病人得到明确诊断，诊断明确率达92．8％。④结论 诊断性腹腔镜技术可作为不明原因腹水病人安全准确的诊断方法。     

FDG PET/CT对经典型不明原因发热的诊断价值

目的:探讨FDG PET/CT在经典型不明原因发热中的诊断价值.方法:对在2007年10月至2009年10月间27例(男性19例,女性8例)经典型不明原因发热病例,行FDG PET/CT显像,PET/CT图像结果判断应用目测法和半定量分析方法.最终诊断包括病理学检查或临床随访.结果:纳入本研究共27例不明原因发热患者,行PET/CT检查后经病理穿刺或病例随访证实,引起不明原因发热的病因共21例,其中包括感染10例,肿瘤性疾病(淋巴瘤)4例,非感染性炎症4例,其他类型3例,未能发现病因6例.FDG PET/CT诊断真阳性21例,假阳性1例,假阴性0例,真阴性5例.灵敏度100%,特异性83.3%;阳性预测值95.5%,阴性预测值100%;准确性96.3%.结论:在诊断不明原因发热患者中,FDG PET/CT显像是灵敏可靠的诊断方法,建议常规检查未能发现病灶或不能确诊的病例,可尽早行FDG PET/CT显像.     

不明原因发热96例临床分析

目的分析不明原因发热的病因和诊断方法,避免误诊和漏诊。方法选择96例符合不明原因发热病例,对病因及最终诊断进行回顾性分析。结果96例不明原因发热患者中85例获得明确诊断,确诊率为88．5％。其中以细菌感染（37．3％）,结核感染（24．0％）、恶性肿瘤（17．7％）为主要病因。结论不明原因发热的主要病因是感染性疾病。     

^18F—FDGPET—CT探查肿瘤原发灶的临床价值

目的对患者进行PET—CT检查，以探查诊断肿瘤原发灶，探讨^18F FDG PET—CT在探查诊断肿瘤原发灶方面的临床价值，以及诊断的优势、敏感性及特异性。方法对需要明确肿瘤原发灶而进行PET—CT检查的41例住院患者通过临床随访、病理诊断及组织学分析方法，进行回顾性分析。结果本研究的35例中，有31例恶性肿瘤患者通过PET—CT检查发现了原发灶，4例患者未能明确恶性肿瘤原发灶的诊断，6例患者排除了恶性肿瘤的诊断。结论^18F FDG PET—CT检查，在探查肿瘤原发灶方面有非常重要的临床价值。     

Seminoma: a review of 15 years experience

We retrospectively reviewed the Charleston Area Medical Center (CAMC) experience with 54 patients diagnosed with seminoma between 1970 and 1986. The median age at diagnosis was 37.5 years (range 20-79). The highest percentage of seminomas occurred between the ages of 30 and 39 (50 percent). Treatment was primarily orchiectomy and radiotherapy since most patients presented with localized disease. The five year survival rate was 100 percent for stage I, 86 percent for stage II, and 75 percent for stage III. Sixteen of 18 (89 percent) stage I patients survived at least 10 years. Of the 12 patients who died, two (16 percent) died of recurrent seminoma, six of cardiovascular disease, and four of a second primary malignancy. The excellent five and 10-year survival rates in stage I seminoma treated with surgery and radiotherapy in this series is similar to others.     

Clinical presentation and management of renal cell carcinoma

A study of clinical presentation and management of renal cell carcinoma (RCC) in 35 patients during the period 1983 to 1997 is presented. The peak age was 40-50 years. Haematuria, abdominal pain, fever of unknown origin and abdominal mass were the commonest presenting features. Computerised tomographic (CT) scanning, intravenous urography (IVU) and magnetic resonance imaging (MRI) were the important diagnostic tools. Early diagnosis and surgery are the most important approaches in management.     

发热待查254例临床分析

目的 探讨发热待查(FUO)的病因及发病趋势,以利于临床早期诊断.方法 回顾性地分析1994-2005年宁夏医学院附属医院收治的符合FUO诊断标准、年龄≥14岁的254例患者的临床资料.结果 254例患者通过多种方法最终确诊223例(87.8%),包括感染性疾病123例(48.4%),其中结核病23例,占感染性疾病的18.7%;结缔组织病40例(15.7%);肿瘤性疾病21例(8.3%);其他疾病39例(15.4%).最终仍原因不明者31例(12.2%).1994-1999年与2000-2005年的资料相比,结核病、恶性肿瘤及原因不明者比例增加,伤寒比例减少.结论 感染性疾病是发热待查的主要病因,其次为结缔组织病和肿瘤性疾病.     

腹腔镜检查对不明原因腹水的诊断价值

①目的 探讨腹腔镜检查对不明原因腹水的诊断价值。②方法 我科于2001年7月～2002年12月利用腹腔镜技术对14例顽固性腹水病人进行探查。③结果 14例病人均通过腹腔镜检查明确诊断，其中癌性腹膜炎腹水占64．3％(9／14)，结核性腹膜炎腹水占21．4％(3／14)，肝硬化腹水占14．3％(2／14)。所有病人术后均恢复顺利，无并发症发生。④结论 腹腔镜检查对不明原因的顽固性腹水是一种安全、准确的诊断方法。     

Solitary diverticulum of the caecal area

Two cases of acute inflammation of a solitary diverticulum of the caecal area are reported, which illustrate the unusual, but well documented, problems that may arise in this condition. The first patient presented with clinical symptoms and signs of acute appendicitis, but the operative findings suggested carcinoma of the caecum. The second patient presented with pyrexia of unknown origin, and the preoperative diagnosis was that of cholangitis. The treatment by right hemicolectomy was successful in both cases, and this operation is recommended for patients who present with a complication of a solitary diverticulum in the caecal area.     

异时性多原发性结直肠癌15例临床分析

目的 探讨异时性多原发性结直肠癌（MCC）的临床特点、诊断及治疗。方法 回顾分析2000年至2013年收治的15例异时性多原发性结直肠癌患者的临床资料,分析异时性多原发性结直肠癌的发病状况,诊断治疗及预后。结果异时性多发性结直肠癌病例占同期所有收治结直肠癌的1.26%（15/1189）,占多发性结直肠癌的36.59%（15/43）,平均间隔时间为3.2年,均为肠镜随访发现,15例首次均行手术切除,再发癌以Dukes B期多见。结论 异时性多原发性结直肠癌临床病理学特点突出,应重视术后肠镜复查,早期发现,积极手术,提高患者生存率。     

坏死性淋巴结炎合并桥本甲状腺炎及自身免疫性溶血性贫血 1 例

目的 通过对以不明原因发热就诊的组织细胞坏死性淋巴结炎合并桥本甲状腺炎及自身免疫性溶血性贫血的病例报道并文献复习,探讨诊治方法。 方法 分析本院发热疾病科收治的1 例以不明原因发热就诊的坏死性淋巴结炎合并桥本甲状腺炎及自身免疫性溶血性贫血患者的临床资料并复习相关文献,总结诊治经验。 结果 患者56 岁女性,临床表现为不明原因发热伴关节肌肉痛、咽痛、一过性皮疹、甲状腺肿大、腋窝及腹股沟淋巴结肿大、贫血,根据其临床表现、病理及骨髓穿刺结果确诊为坏死性淋巴结炎合并桥本甲状腺炎及自身免疫性溶血性贫血。 结论 此例病症临床罕见,对不明原因发热的患者应想到坏死性淋巴结炎及多种自身免疫性疾病伴发的可能,确诊依据病理,治疗主要依靠肾上腺糖皮质激素。     

Amyloidosis of immunoglobulin origin: useful treatment?

Six patients are presented in whom a diagnosis of amyloidosis of immunoglobulin origin was established by light and electron microscopy of biopsy samples. Treatment with a regimen of intermittent doses of melphalan and prednisone resulted in a survival of 48-82 months in four of the patients while two patients died within three months of diagnosis, too soon for the therapy to have been effective. When compared with published series which suggest that the median survival of this condition is approximately 14 months, our results suggest that this treatment prolongs life successfully. These patients also enjoyed a greatly improved quality of life while receiving treatment.     

骨髓细胞学检查在贫血诊断中的临床价值探讨

目的探讨骨髓细胞学检查在贫血病因诊断中的临床价值。方法对770例贫血待查患者骨髓细学检查的临床资料进行分析。结果770例贫血待查患者经骨髓细胞学检查,有588例（76.4%）确诊病因。结论骨髓细胞学检查对贫血的确诊、贫血类型的确定具有十分重要的临床意义。     

倾斜试验对原因不明晕厥诊断的探讨

对连续就诊的２７例原因不明晕厥患者进行倾斜试验（ＨＵＴ），阳性者４例，阳性率为４／２７；阴性的２３例中有１６例加做异丙肾上腺素（ＩＳＯ）倾斜试验，阳性者１０例，阳性率为１０／１６；７例因不能耐受未能完成全程ＩＳＯ倾斜试验。基础倾斜试验及ＩＳＯ倾斜试验阳性者共１４例。试验表明，基础倾斜试验直立倾斜时间不宜短于４５ｍｉｎ，观察ＨＵＴ诱发晕厥前有否心动过速有助于药物选择。     

老年人不明原因发热45例

目的 分析老年人不明原因发热（FUO）的病因。方法 选择1999年1月。2004年12月符合FUO诊断标准的老年患者45例进行分析。结果 40例（88.9％）老年FUO患者通过血清学和（或）细菌学、体液或骨髓、组织活检、手术探查以及观察临床过程和（或）治疗反应明确诊断。感染性疾病占42.5％（17／40），其中结核病8例，占感染性疾病的47％（8／17），肿瘤性疾病占35％（14／40），结缔组织病占12.5％（5／40），其他疾病占10％（4／40），病因不明占11，1％（5／40）。结论 感染是我院老年FUO患者的主要病因，其次为肿瘤性疾病和结缔组织病。正确的诊断策略可提高确诊率，减少或避免误诊或漏诊。     

368例发热原因待查患者诊断分析

目的 分析以"发热原因待查"收入感染科患者的病因构成、诊断方法,总结临床诊断思路,为诊断发热患者提供科学的临床思维方法.方法 回顾性分析2002年1月至2009年12月由门诊初诊为"发热原因待查"收住解放军第三○二医院的368例患者的最终病因诊断,诊断手段以及其病因与性别、年龄及热程之间的关系.结果 368例患者中11...     

骨髓细胞学检查应用于贫血诊断的临床价值探讨

目的:探讨骨髓细胞学检查应用于贫血诊断的临床价值。方法:回顾性分析314例贫血患者的骨髓细胞学检查临床资料。结果:314例贫血患者确诊297例(94.6%),不明原因17例(5.4%)。结论:骨髓细胞学检查应用于贫血患者的诊断,对于明确病因,对症治疗是很有意义的,值得在临床上应用和推广。     

Sinonasal natural killer/T-cell lymphoma presenting as pyrexia of unknown origin with nasal symptoms

A 68-year-old Chinese man presented with an eight-month history of pyrexia of unknown origin and chronic sinusitis despite multiple courses of antibiotics. He underwent extensive investigations, including workups for infections, chronic granulomatous diseases and malignancy. Nasal biopsies were performed twice under local anaesthesia, but did not show any evidence of malignancy. Eventually, the patient was diagnosed with natural killer (NK)/T-cell lymphoma, nasal variant, based on histopathological findings from harvested deep tissue obtained via functional endoscopic sinus surgery. This study highlights that, for patients presenting with pyrexia of unknown origin and nasal symptoms, NK/T-cell lymphoma must be considered as a differential diagnosis. Generous amounts of tissue should be harvested under general anaesthesia rather than limited tissue under local anaesthesia, in order to facilitate and ensure a definitive diagnosis.     

Case Report: Multiple myeloma in a patient with fever of unknown origin and cholestasis

THE DIFFERENTIAL DIAGNOSIS OF FEVER of unknown origin includes infectious diseases, malignancies and connective tissue diseases. Multiple myeloma is not usually included in the differential diagnosis, nor is it considered a frequent cause of cholestasis in the absence of amyloidosis. We report a case of multiple myeloma in a patient presenting with a long-standing fever and cholestasis. The patient underwent a long and unfruitful series of diagnostic procedures, including liver biopsy. The clue to the diagnosis, established with a marrow biopsy, was the presence of a paraprotein in the serum.