严重急性呼吸综合征患者静脉血白细胞及血沉的分析

目的 分析和总结严重急性呼吸综合症(SARS)患者静脉血白细胞计数、分类及血沉的变化。方法 在全自动血球分析仪和血沉仪上进行静脉血白细胞和分类及血沉的检测。结果 87例SARS患者静脉血检查中，淋巴细胞绝对值(LYM)、中性粒细胞百分比(GRA％)和血沉(ESR)与正常对照组比较均有显著性差异，75％的患者白细胞总数正常，25％的患者减低。SARS患者静脉血血象变化表现为白细胞总数正常或者减低；淋巴细胞绝对值减低和中性粒细胞百分比相对升高；血沉升高。结论 这些特点可以作为SARS疑似病例筛查的有用指标，淋巴细胞绝对值减低应为主要的特征，动态观察淋巴细胞绝对值改变可以作为病情恢复的一个参考指标。     

MRI与脑脊液检查在颅内结核疗效评估中的价值

目的分析MRI与脑脊液检查对颅内结核疗效评估中的价值.材料与方法回顾性分析2012年1月至2017年12月在本院进行MRI检查的400例颅内结核患者,均进行抗结核治疗,比较治疗前和治疗6个月后病变大小、数量、脑脊液生化指标(脑脊液蛋白、葡萄糖、脑脊液腺苷脱氨酶)、脑脊液细胞学指标(白细胞计数、单核细胞、中粒细胞计数、颅内压、淋巴细胞计数).结果MRI影像学图片显示治疗6个月后患者的病灶数、病灶大小均减少(P<0.05),治疗6个月内病灶的消失率为71.59％(5767/8056);治疗6个月后患者的脑脊液蛋白、葡萄糖、脑脊液腺苷脱氨酶水平低于治疗前,氯化物水平高于治疗前(P<0.05);治疗6个月后患者的白细胞计数、单核细胞、中粒细胞计数、颅内压、淋巴细胞计数水平较治疗前明显降低(P<0.05);治疗6个月后MRI检查显示316例治愈,治愈率79.00％,脑脊液检查显示298例治愈,治愈率74.50％,两者检查结果比较差异无统计学意义(P>0.05),Kappa值=0.595.结论抗结核治疗后患者的病灶数目和大小均降低,脑脊液各项检查指标均有所改善,颅内结核的MRI检查和脑脊液检查对患者预后情况的评估一致性较高,两者联合检测有助于医生评估治疗效果和预后.     

血白介素-6、降钙素原及淋巴细胞亚群对脓毒症病情及其预后的评估价值

目的:探讨白介素-6(IL-6)、降钙素原(PCT)及淋巴细胞亚群对脓毒症患者的病情严重程度及其预后的评估作用。方法:以2018年1月-2020年2月广东省佛山市第一人民医院收治的脓毒症患者为研究对象,选择存活组和死亡组各50例,另选取同期进行体检的30例健康者作为对照组,比较其IL-6、PCT及淋巴细胞亚群水平。结果:存活组与死亡组治疗前、治疗后24 h的IL-6水平无明显差异(P0.05),治疗后7 d、28 d的IL-6水平差异明显(P0.05);死亡组与存活组治疗后24 h、7 d、28 d的PCT水平差异明显(P0.05);死亡组与存活组在治疗前的淋巴细胞亚群各项指标均不存在差异(P0.05);治疗后的淋巴细胞亚群各项指标差异显著(P0.05);两组患者在淋巴细胞亚群各项指标上与对照组均有较大差异(P0.05)。结论:动态检测IL-6、PCT及淋巴细胞亚群可作为脓毒症患者病情严重程度及其预后的评估指标之一。     

ALL和N-ALL白血病患者治疗前后外周血T淋巴细胞亚群和免疫球蛋白变化及其对病情监测和预后判断的价值

目的:分析急性淋巴细胞性白血病(ALL)与非急性淋巴细胞性白血病(N-ALL)患者治疗前后外周血T淋巴细胞亚群和免疫球蛋白变化及其对病情监测和预后判断的价值。方法:选取本院106例白血病患者,其中ALL患者48例(ALL组),N-ALL患者58例(N-ALL组),并同期选择在本院健康体检的人员54例为正常对照组。对各组外周血免疫球蛋白IgA、IgG和IgM进行检测,并通过细胞生物玻片法对其T淋巴细胞亚群绝对值进行测定。按照治疗后有无改善将106例患者又分为非改善组55例(其中ALL患者25例,N-ALL患者30例)与改善组51例(其中ALL患者23例,N-ALL患者28例)。结果:106例白血病患者IgA、IgG和IgM的水平均显著低于对照组(P0.05),其外周血CD3~+、CD3~+CD4~+/CD3~+CD8~+比值与CD3~+CD4~+T细胞绝对值均显著低于对照组(P0.05);CD3~+CD8~+T细胞绝对值与对照组比较无明显差异(P0.05)。治疗后改善组IgA、IgG和IgM均较治疗前显著提高(P0.05),与对照组比较无明显差异(P0.05);外周血CD3~+、CD3~+CD4~+/CD3~+CD8~+比值与CD3~+CD4~+T细胞绝对值也较治疗前显著提高(P0.05),与对照组比较无明显差异(P0.05)。相比治疗前,治疗后未改善组各项指标均无明显差异(P0.05),而且CD3~+、CD3~+CD4~+/CD3~+CD8~+比值和CD3~+CD4~+T细胞绝对值均显著低于对照组(P0.05),而CD3~+CD8~+T细胞绝对值均较对照组高(P0.05)。结论:治疗后ALL和N-ALL患者外周血T淋巴细胞亚群(CD3~+、CD3~+CD4~+T细胞)与免疫球蛋白(IgA、IgG、IgM)的水平明显改善,对各项指标进行检测有助于病情监测和预后评估。     

雷神山医院19例新型冠状病毒肺炎危重患者实验室数据动态观察与分析

目的动态分析19例新型冠状病毒肺炎(简称新冠肺炎)危重患者实验室常规检测指标的变化,评估其在新冠肺炎病情发展中的变化趋势,为临床治疗、预后提供科学依据。方法回顾性分析19例新冠肺炎危重患者在入院治疗过程中所检测的白细胞计数、淋巴细胞百分比、血小板计数、D-二聚体水平、尿蛋白和尿潜血等常规指标的结果。结果19例新冠肺炎危重患者,入院时白细胞计数升高的有4例(21.1%);入院到转归白细胞计数在参考范围内波动的有13例(68.4%);19例患者中有17例(89.5%)入院时淋巴细胞百分比呈降低状态,治疗后期逐步向上都呈恢复趋势,其中8例(42.1%)转归时淋巴细胞百分比恢复正常水平。血小板计数:19例患者中有17例(89.5%)在整个治疗期间未见减少。D-二聚体水平:19例患者入院时都处于较高水平,治疗中有波动,曾出现高峰期,后期总体向好发展,其中死亡1例,其D-二聚体水平一直维持在较高水平;出院时5例(26.3%)D-二聚体水平恢复正常。收集尿检数据16例,尿蛋白阳性8例(50.0%),尿潜血阳性有11例(68.8%),持续阳性(超过30 d)的有6例(37.5%)。结论在常规项目中白细胞计数、淋巴细胞百分比、D-二聚体水平、尿蛋白和尿潜血等指标,可能是反映新冠肺炎患者病情严重的重要指标,动态观察这些指标对监测新冠肺炎患者病情发展、指导临床用药及预后判断等方面意义重大。     

急性白血病患者T、B淋巴细胞的检测与分析

目的:探讨不同类型的急性白血病患者外周血T淋巴细胞亚群、B淋巴细胞和NK细胞等在疾病的不同时期的变化及其临床意义。方法:采用流式细胞术检测95例初诊白血病患者[急性淋巴细胞白血病(ALL)43例,急性髓系白血病(AML)52例]诱导治疗前后及50例正常对照者外周血T淋巴细胞亚群、B淋巴细胞、NK细胞及Treg细胞百分比。结果:初诊白血病各组CD3~+、CD3~+CD4~+、CD3~+CD8~+、NK细胞阳性率和CD4~+/CD8~+比值均明显低于正常对照组(P0.05),治疗后完全缓解患者的上述指标均明显高于治疗前(P0.05)。初诊白血病各组患者Treg细胞阳性率均高于正常对照组(P0.01),AML和ALL治疗组完全缓解患者Treg细胞阳性率较治疗前有所降低(P0.05)。AML初诊组CD3-CD19~+细胞阳性率明显低于正常对照组(P0.01),ALL初诊组CD3-CD19~+细胞阳性率高于正常对照组(P0.01);治疗后AML组缓解患者CD3-CD19~+细胞阳性率高于治疗前(P0.05),ALL组缓解患者CD3-CD19~+细胞阳性率明显低于治疗前(P0.01);ALL治疗后未缓解者CD3-CD19~+细胞阳性率明显低于治疗前(P0.01);ALL治疗后未缓解者的其余各项指标及AML治疗后未缓解者各项指标与治疗前比较无统计学差异。结论:初诊白血病各组T淋巴细胞亚群、B淋巴细胞和NK细胞的变化明显,完全缓解组的上述指标基本恢复正常,说明T淋巴细胞亚群、B淋巴细胞、NK细胞水平检测在评价急性白血病严重程度、疗效及判断患者预后有一定的临床价值。     

温阳法联合化疗治疗晚期非小细胞肺癌的临床效果观察

目的 探讨晚期非小细胞肺癌患者给予温阳法联合化疗治疗的效果,为临床提供参考。方法 对2022年1月至2023年1月北京朝阳中西医结合急诊抢救医院收治的80例晚期非小细胞肺癌患者的临床资料进行回顾性分析。根据治疗方案的不同分为对照组[40例,给予紫杉醇与顺铂联合(TP)化疗方案治疗]和观察组(40例,给予温阳法联合TP化疗方案治疗)。比较两组患者临床疗效、中医证候积分及卡劳夫斯基行为状态量表(KPS)评分、免疫功能指标和不良反应发生情况。结果 观察组患者整体疗效优于对照组,客观缓解率(ORR)和疾病控制率(DCR)高于对照组(均P<0.05)。两组患者治疗后食少纳呆、体倦乏力、神疲懒言、畏寒肢冷、尿少浮肿及大便稀溏中医证候积分均低于治疗前,且观察组均低于对照组(均P<0.05)。两组患者治疗后KPS评分均高于治疗前,且观察组高于对照组(P<0.05)。两组患者治疗后CD4⁺T淋巴细胞百分比、CD4⁺/CD8⁺比值均高于治疗前,CD8⁺T淋巴细胞百分比均低于治疗前,且观察组上述免疫指标...     

外周血淋巴/中性粒细胞比值及淋巴/单核细胞比值对鼻咽癌患者预后的评估

目的 探讨鼻咽癌患者治疗前外周血淋巴细胞与中性粒细胞比值(LNR)和淋巴细胞与单核细胞比值(LMR)等指标评估鼻咽癌患者预后的价值。方法 回顾性分析2015年12月～2017年10月在安徽省肿瘤医院行鼻咽癌放、化疗治疗的160例鼻咽癌患者的血常规结果,纳入本组研究的临床分期为Ⅰ期6例、Ⅱ期21例、Ⅲ期62例、Ⅳ期71例,采用Sysmex–XE 5000血细胞分析仪检测患者外周血白细胞计数(WBC)、中性粒细胞计数(N)、淋巴细胞计数(L)、单核细胞计数(M)等指标,计算淋巴细胞与中性粒细胞比值(LNR)、淋巴细胞与单核细胞比值(LMR)。结果 鼻咽癌患者与健康体检对照组比较,白细胞计数(WBC)、中性粒细胞百分率(NEUTR%)、淋巴细胞百分率(LYR%)、 LNR的差异无统计学意义(P0.05);鼻咽癌病情稳定患者治疗前LNR、LMR值明显低于发现远处转移及复发鼻咽癌患者(P0.05)。结论 定期测定鼻咽癌患者治疗前外周血LNR、LMR可以作为评价鼻咽癌患者无进展生存预后的有用指标。     

成人急性白血病患者白细胞和血小板中活性氧簇的监测研究

目的 :检测成人急性白血病患者外周血白细胞和血小板中活性氧簇(reactive oxygen species,ROS)阳性表达的水平及其在治疗前、后的变化,探讨白细胞和血小板中ROS水平的差异及其与疾病转归间的相关性。方法:选取16例成人急性白血病患者和16名健康对照者(健康对照组),16例患者按白血病分型分为急性淋巴细胞白血病组和急性髓细胞白血病组,分别观察治疗前和治疗后外周血白细胞和血小板中ROS的情况。采用流式细胞术检测外周血中白细胞和血小板中ROS阳性的表达水平,并用表达ROS阳性细胞的百分比来反映细胞内的ROS水平。结果:急性白血病患者治疗前、后外周血白细胞及血小板中的ROS水平均明显高于健康对照组(P<0.01);且患者治疗前外周血白细胞及血小板中的ROS水平显著高于治疗后(P<0.05),健康对照组和急性白血病患者治疗后外周血白细胞与同组血小板内的ROS水平间不存在相关性。所有患者白细胞中白血病细胞所占百分比与ROS阳性表达间不存在相关性。急性白血病患者治疗前白细胞内的ROS水平明显高于同一患者血小板内的ROS水平(P<0.01)。急性淋巴细胞白血病患者与急性髓细胞白血病患者外周血白细胞、血小板中表达ROS阳性的百分比差异无统计学意义。结论:动态监测急性白血病患者外周血白细胞及血小板中ROS阳性的百分比对治疗疗效和预后判断有一定参考意义。     

他克莫司联合甲泼尼龙治疗肾病综合征患者的临床疗效及安全性分析

目的 探究肾病综合征(NS)患者采用他克莫司联合甲泼尼龙治疗的临床效果及安全性,为临床治疗提供参考。方法 选取2022年1月至2023年2月京东誉美中西医结合肾病医院及河南誉美肾病医院收治的60例NS患者为研究对象,按照随机数字表法分为对照组(30例,采用甲泼尼龙治疗)和观察组(30例,采用他克莫司联合甲泼尼龙治疗)。比较两组患者临床疗效、肾功能指标、免疫功能指标、血清炎症因子水平及不良反应发生情况。结果 治疗后,观察组患者临床疗效优于对照组,治疗总有效率高于对照组(均P<0.05)。治疗后,观察组患者血肌酐(Scr)、24 h尿蛋白定量、血尿素氮(BUN)水平均低于对照组,血清白蛋白(ALB)水平高于对照组(均P<0.05);治疗后,观察组患者CD4⁺T淋巴细胞百分比、CD4⁺/CD8⁺比值高于对照组,CD8⁺T淋巴细胞百分比低于对照组(均P<0.05);治疗后,观察组患者C反应蛋白(CRP)、白细胞介素-6(IL-6)水平均低于对照组,白细胞计数(WBC)高于对照组(均P<...     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.