从耳鼻咽喉科误诊病例谈临床思维

临床误诊误治的原因是多方面的，而医师的思维方法是主要原因之一，在很大程度上关系着诊断的正确琚否。通过数例耳咽喉科典型病例分析，发现导致思维错误的原因有：仅认同表面现象，不能透过现象看本质；一种思维倾向掩盖另一种思维倾向，形成思维定势；主观臆断，不依据客观实际病情做诊断；迷信仪器设备等。     

小儿过敏性紫癜45例临床分析

对我科 1995年 1月至 1998年 12月收治的过敏性紫癜(HSP) 4 5例分析如下。1　临床资料男 2 8例 ,女 17例 ,发病最小年龄 4岁 ,最大为 14岁 ,平均7.8岁 ,男女之比为 1.6∶ 1。1.1　临床表现　皮肤紫癜 :45例患者均先后出现皮肤紫癜 ,紫癜多见于双下肢和臀部 ,以单纯性皮肤紫癜为首发症状者 2 5例(仅占 5 5 .6 % )。关节症状 :肿胀、疼痛或功能障碍 18例 (占40 % ) ,受累依次为膝关节、踝关节、肘关节、腕关节和指关节。以关节症状首发 3例 ,早于皮肤紫癜 1～ 7天。其中 1例曾在早期误诊为风湿性关节炎。胃肠道症状 :腹痛 2 3例 ,便血 13例 …     

46例过敏性紫癜患儿的临床特征分析

目的：探讨儿童过敏性紫痰的临床特征。方法：对46例过敏性紫痰患儿的发病特征、临床表现、预后进行分析。结果：过敏性紫痰患儿从2000—2005年发病率呈上升趋势；发病季节以第一、四季度为高峰，与呼吸道疾病的高发季节相吻合；感染占第一位，胃肠受累为最常见，过敏性紫痰肾炎是影响预后的关键。结论：过敏性紫痰患儿的发病率有逐年上升的趋势，发病诱因感染占第一位。其表现较多的是肾外症状，消化道症状最明显，并发紫痰性肾炎者预后不佳。     

过敏性紫癜98例诊治及误诊分析

目的 探讨过敏性紫癜的误诊原因及昆明山海棠治疗肾型紫癜的疗效.方法 回顾性分析98例过敏性紫癜的临床资料、误诊情况、治疗经过及结果.结果 98例过敏性紫癜患者中有16例误诊为胃肠道疾病、肾炎、关节炎.28例肾型紫癜除2例好转外,其余均于3个月内痊愈.结论 过敏性紫癜症状不典型时容易误诊;昆明山海棠治疗肾型紫癜效果好.     

急性腹痛为主要症状的过敏性紫癜20例误诊分析

现将近年来以腹痛、便秘、呕吐为主要症状而误诊的胃肠型过敏性紫癜 2 0例分析报告如下。1　临床资料2 0例急诊患者 ,男性 12例 ,女性 8例 ,年龄 5～ 73岁。发病前有食物过敏史 4例 ,药物过敏史 2例 ,上感史 3例 ,接触杀虫剂史 1例。所有患者均以腹痛为首发症状。皮肤出现紫癜均发生于腹痛后 1～ 8ｄ。伴有关节肿痛者 6例。腹痛部位发生于脐周 13例、下腹部 5例、全腹部 2例。腹痛性质为隐痛或阵发性绞痛。伴食欲减退、恶心呕吐 13例 ,鲜红色黏液血便 7例 ,黑便 1例。局部压痛 6例 ,不定点压痛 12例 ,反跳痛 2例。急查血象 :白细胞 >10× 10…     

以腹痛为首发症状的儿童过敏性紫癜早期误诊10例分析

现将我院1998-2005年收治的以腹痛为首发症状的儿童过敏性紫癜早期误诊10例分析如下。 1临床资料 1．1一般资料本组男7例，女3例，年龄5～14（平均9）岁，发病就诊时间2～10d。本组均以腹痛为首发症状，在胃肠道症状出现后均有皮肤紫癜，关节受累3例，肾脏受累4例。腹痛性质：阵发性痛8例，持续性痛2例，以脐周疼痛为主，1例中上腹疼痛，1例右下腹疼痛。伴呕吐6例，解黑便1例，腹胀腹泻2例。     

过敏性紫癜146例临床分析

过敏性紫癜是一种变态反应性血管炎症性紫癜，临床常见。作者收集近3年收治住院的过敏性紫癜146例，临床分析如下。1临床资料1．1一般资料本组男81例，女65例；年龄8岁以下25例，8～16岁80例，17～30岁30例，31～68岁11例。初发103例，再发43例。发病季节以冬春季最常见，占74．6％。病程长短不一，其中1例长达15年之久。1．2诱因有明显诱因88例（60．2％），其中上呼吸道感染25例，扁桃腺炎8例，腮腺炎1例，肺炎3例，原发性肺结核5例，支周炎1例，脓疮疮1例，寄生虫感染35例（其中蛔虫29例，钩虫4例，鞭虫2例），进食鱼、蛋、奶制品各1例，…     

Acute abdominal pain in childhood and adolescence: assessing the impact of sonography on diagnosis and treatment

Purpose

To assess the impact of ultrasonography on defining the diagnostic and therapeutic pathways for pediatric patients admitted to the emergency department for acute abdominal pain.

Methods

We performed a retrospective study of all patients aged <16 years with acute abdominal pain who underwent ultrasound examination at our Diagnostic Imaging Department from October 2010 to March 2012. We investigated for each patient the pathway following ultrasound examination and definitive diagnosis. The impact of ultrasonography was defined based on the frequency with which the information resulting from this examination confirmed or denied the diagnostic suspicion made by the emergency physician on the basis of clinical and laboratory findings.

Results

In 497/729 patients (69 %), ultrasound examination did not determine variations in the diagnostic and therapeutic pathways, either because it confirmed the outcome of clinical examination and laboratory tests, or because, even addressing in the opposite direction to these, the emergency physician did not consider its result because of being particularly alarmed or sufficiently reassured by clinical examination and laboratory tests. In the remaining 232/729 cases (31 %), ultrasound examination determined an increase or a reduction of the provided care and attention (subsequently proved justified in the vast majority of cases) in spite of what was initially assessed based on clinical examination and laboratory tests.

Conclusions

The results of our retrospective study demonstrated that ultrasonography was a valuable tool in the management of pediatric patients with acute abdominal pain together with clinical examination and laboratory tests.     

Chronic abdominal pain in childhood: diagnosis and management

More than one third of children complain of abdominal pain lasting two weeks or longer. The diagnostic approach to abdominal pain in children relies heavily on the history provided by the parent and child to direct a step-wise approach to investigation. If the history and physical examination suggest functional abdominal pain, constipation or peptic disease, the response to an empiric course of medical management is of greater value than multiple "exclusionary" investigations. A symptom diary allows the child to play an active role in the diagnostic process. The medical management of constipation, peptic disease and inflammatory bowel disease involves nutritional strategies, pharmacologic intervention and behavior and psychologic support.     

风湿病引起胸痛、腹痛的鉴别诊断及处理

风湿性疾病可导致患者出现胸痛、腹痛的症状,很多患者病情隐匿,诊断困难,而部分患者的病情凶险,甚至出现生命危险。因此,当患者出现胸痛腹痛时,应注意风湿病的存在,本文旨在总结风湿病引起胸痛腹痛的临床特点,及时做好鉴别诊断,改善患者预后。     

Abdominal pain in a child after blunt abdominal trauma: an unusual injury

We report a case of perforation of a walled off appendiceal abscess in a 5-year-old boy who sustained blunt abdominal trauma. The past medical history was significant only for a 4-day episode of abdominal pain 1 month prior to this presentation. Initial laboratory studies were unremarkable, and radiographic studies showed free fluid in the pelvis with no evidence of solid organ injury, but inflammation of the right colon. The final diagnosis was made at laparotomy. We emphasize this unique presentation and review the literature on traumatic appendicitis in children.     

腹腔镜探查对不明原因腹痛的诊断及治疗价值分析

目的探讨腹腔镜探查在不明原因腹痛诊断和治疗中的应用价值。方法回顾性分析进行腹腔镜探查术的不明原因腹痛患者30例的临床资料。结果 30例患者均经腹腔镜探查明确诊断,其中上消化道穿孔26例,原发性胃癌2例,肠结核2例。对26例穿孔患者及时予穿孔修补,2例胃癌患者行胃镜检查未发现原发病灶,予化疗,2例肠结核患者予抗痨治疗。结论腹腔镜探查对于不明原因腹痛的诊断具有明显的直接性和可靠性,同时对于绝大多数患者能够达到良好的治疗效果,值得临床推广应用。