警惕以颈肩痛为主要表现的肺癌(附3例报告)

目的:提高对肺癌肺外表现的认识.方法:分析3例以颈肩痛为主要表现的肺癌患者的病例资料.结果:患者均以颈肩部疼痛为首发症状就诊于康复医学科或理疗科,后经查体及X线胸片检查诊断为晚期肺癌,并经胸水细胞学或病理检查确诊.结论:临床医师应熟悉肺癌的肺外表现,对不明原因的颈肩背疼痛,需警惕肺癌可能.     

肺癌骨转移四例误诊分析

肺癌骨转移四例误诊分析江苏省淮阴市第二人民医院［２２３００１］周寒松肺癌易经血行发生骨转移，但当肺癌的呼吸系统症状缺如或不明显，而以骨转移店为首发表现，Ｘ线特征又不典型时，易误诊为骨髓炎或原发性恶性骨肿瘤。我院１９８４年１１月至１９９４年１０月共遇４...     

以骨转移症状首发的肺癌临床特征及误诊分析

目的 探讨以骨转移症状首发的肺癌临床特点,分析误诊原因及预后.方法 回顾分析我院2001年6月～2010年6月诊治的50例以骨转移症状首发的肺癌临床资料.结果 50例均有骨痛,20例伴神经系统症状,6例发生病理性骨折.骨转移以多发、溶骨性骨破坏为主.本组初诊时误诊46例,误诊率92％,误诊时间3d～3个月,误诊疾病前3位为腰椎间盘突出症、椎体骨质增生和原发性骨肿瘤.经手术病理确诊46例,细胞学作出恶性肿瘤诊断但未明确分型2例,影像学确诊2例.本组1年生存率为10％,中位生存期为4个月.结论 以骨转移症状为首发表现的肺癌以多发性、溶骨性骨破坏为特征,腺癌骨转移发生率高,预后差,误诊率高.临床医生对此应高度重视,以减少误诊.     

以骨转移瘤为首发表现肺癌10例临床X线误漏诊分析

肺癌易发生骨转移,当以骨转移瘤为首发表现,无呼吸系统症状时,易将骨转移瘤误诊为它种疾病,或将原发肺癌漏诊。我院1980年11月至1995年10月共遇到10例,临床及X线均误诊及漏诊,现报告分析如下。 1 临床资料 1.1 本组男8例,女2例,年龄30～44岁2例,45～59岁3例,60岁以上5例。首发症状:局部轻度     

提高对骨转移瘤特殊X线表现的认识

骨转移瘤在X线平片病灶不典型或原发癌症状不明显时,常易误诊为原发性恶性骨肿瘤或其他骨疾患。我院1984年10月～2001年10月共收治骨转移瘤325例,其中32例X线平片误诊,误诊率9.8％。现分析骨转移瘤的X线特征及误诊原因如下。     

以颈痛为主诉的颈椎嗜酸性肉芽肿1例

<正>颈痛常见于颈椎病变、颈部软组织炎症、甲状腺炎、颈部恶性肿瘤等,是临床上的常见症状。由于近年来疼痛诊疗水平不断增强,以疼痛或其他症状为主诉的少见、罕见疾病到疼痛科就诊的病人不断增多。这类疾病早期表现不典型,容易导致误诊。本文回顾临床收治的1例少见的颈椎嗜酸性肉芽肿,总结临床经验并复习文献,以提高临床医师对颈痛     

儿童鼻咽癌的影像学表现及误诊分析

目的 探讨儿童鼻咽癌的临床特征、影像学表现及误诊误治原因。方法 回顾性分析1993年1月～2002年12月收治的42例儿童鼻咽癌的临床特征、影像学表现、误诊误治原因及确诊方法。结果 临床多以颈部肿块(18例)，头痛(10例)，鼻塞、鼻衄(8例)，耳鸣、耳痛、听力下降(9例)，面部疼痛(8例)，视力下降、复视或斜视(5例)等为首发症状，部分患儿出现两种以上症状。影像学表现为鼻咽部不规则软组织肿块或软组织不同程度增厚，邻近组织受侵，周围淋巴结肿大，颅底骨质破坏和颅内蔓延。增强扫描肿瘤呈不同程度强化．误诊38例，其中误诊为颈淋巴结结核者12例，血管神经性头痛7例，鼻窦炎6例，中耳炎5例。全部病例均在鼻咽镜下行鼻咽腔活组织检查或颈淋巴结活组织检查和(或)细胞检查，免疫组化和VCA-IgA、EA-IgA等检查确诊。结论 影像学检查是诊断儿童鼻咽癌的重要方法，认识不足和首发症状不典型是误诊的主要原因；掌握儿童鼻咽癌的临床特征并与多种检查相结合是减少误诊误治的主要措施。     

颈-心综合征误诊7例原因分析

颈-心综合征(Cervicardiac Syndrome)是由颈椎病及/或颈、肩、背部软组织损伤引起的,以患者心脏症状为主诉及心电图ST-T改变的一组症候群,主要有心前区疼痛、胸闷、心悸、气短等表现[1].颈椎病是中老年人的常见病,且近年来发现发病年龄逐渐提前,所以颈.心综合征并不少见.但颈椎病患者常因心绞痛、心律失常、心电图改变而就诊,加之临床医师对冠心病警惕性较高,故将颈.心综合征误诊为冠心病较多见.     

心肌梗死的心电监护及护理体会

心肌梗死（心梗）是心内科的常见急诊，临床表现为胸骨后或心前区呈压榨性或紧缩性疼痛，时间常超过30min，常放射到左肩背、颈部。当心脏下壁梗死时，可出现上腹部疼痛，伴恶心、呕吐、食欲下降等，易误诊为胃痉挛或急性胃肠炎。少数可有颈、咽或下颌及背部疼痛。根据典型临床症状，典型心肌梗死心电图表现，血清酶上升，可作出心肌梗死的诊断。在急性心梗后数分钟，心电图即有异常改变。     

以骨转移症状为主要表现的前列腺癌10例误诊分析

目的分析前列腺癌骨转移误诊的原因,提高诊治水平。方法 对我院2002～2009年经病理检查确诊的10例前列腺癌骨转移的临床资料进行回顾性分析。本组10例均以疼痛为主要表现,其中腰骶部疼痛5例,胸背部疼痛3例,颈部疼痛2例。结果本组误诊为腰椎间盘突出症、髋关节病各3例,骨质疏松症、多发性骨髓瘤各2例。入院后经直肠指诊、前列腺B超、前列腺特异性抗原及病理检查确诊为前列腺癌骨转移,给予手术、放化疗等治疗后,骨痛症状均有好转。平均随访30个月,2年、5年生存率分别为85.6%和59.1%。结论对以骨痛为主要表现的老年男性,应考虑前列腺癌骨转移的可能,及时行相关检查,以免误诊。     

唑来膦酸联合化疗治疗肺癌骨转移疼痛的护理

[目的]总结25例唑来膦酸联合化疗治疗肺癌骨转移疼痛的护理.[方法]回顾性分析25例唑来膦酸联合化疗治疗肺癌骨转移疼痛病人的临床资料.[结果]治疗结束后1周,疼痛0级7例,Ⅰ级10例,Ⅱ级5例,Ⅲ级3例;完全缓解(CR)7例,部分缓解(PR)13例,无变化(NC)5例,有效率为80%;发生骨髓抑制5例,Ⅲ度胃肠道反应4例,发热4例,肌肉酸痛3例.[结论]加强唑来膦酸联合化疗治疗肺癌骨转移疼痛的护理可减轻了病人的痛苦,使其顺利完成了治疗.     

血清Ⅰ型胶原吡啶交联终肽、骨钙素在肿瘤骨转移中的应用

目的探讨骨胶原吸收指标血清Ⅰ型胶原吡啶交联终肽（ICTP）和骨形成指标血清骨钙素（OC）二者在肿瘤骨转移的应用价值。方法收集我院肿瘤科经病理确诊的肺癌患者血清65例，乳腺癌患者血清36例，通过影像学诊断，将其分为骨未转移组和骨转移组两组。并征集我院健康体检人群41例作为健康对照组，分别定量测定血清ICTP、OC和碱性磷酸酶（ALP）浓度。结果血清ICTP在肺癌和乳腺癌骨转移组[（27．80&#177;11．14）μg／L和（122.33&#177;34．92）μg／L]均显著高于骨未转移组[（8．95&#177;3．81）μg／L和（8．40&#177;4．59）μg／L]，差异有统计学意义（P〈0．01），骨未转移组较健康对照组[（5．16&#177;1．76）μg／L]亦有极显著性差异（P〈0．01），血清OC值在乳腺癌骨转移组[（69．31&#177;36．17）ng／mL]亦显著高于骨未转移组[（15．54&#177;6．09）ng／mL]，差异有统计学意义（P〈0．01），而肺癌骨未转移组血清OC值较健康对照组以及肺癌骨转移组较肺癌骨未转移组差异均无统计学意义（P〉0．05）。血清ICTP在诊断肺癌和乳腺癌骨转移中是特异性高、敏感度较好的指标，血清OC在诊断肺癌骨转移中单独使用敏感度不够，意义不大，但在诊断乳腺癌骨转移时特异度和敏感度均较好。两者联合诊断乳腺癌骨转移的敏感度为96．3％，特异度为96．7％，联合诊断肺癌骨转移的敏感度为80．3％，特异度为84．2％。结论可根据需要单独或联合应用血清ICTP和OC，作为除影像学外诊断肿瘤骨转移有用的实验室诊断指标。     

肺曲霉病30例临床分析

目的探讨肺曲霉病的临床表现和影像学特点。方法回顾性调查我院2000年1月--2006年4月确诊或拟诊的30例肺曲霉病，并进行分析研究。结果肺曲霉病的症状主要表现为咳嗽及间歇咯血，伴有发热、胸痛等。影像学表现多样，其中曲霉球有特异性X线胸片表现。确诊方法主要靠病理检查，肺曲霉病易误诊为肺结核和肿瘤。结论肺曲霉病的临床表现不典型，缺乏特异性，误诊率高。病理组织活检具有重要的诊断价值。     

Rare case of brucellosis misdiagnosed as prostate carcinoma with lumbar vertebra metastasis: A case report

BACKGROUNDProstatitis caused by Brucella infection is rare and usually lacks typical lower urinary tract symptoms. However, Brucella infection can cause serum prostate-specific antigen levels to become abnormally elevated. When concurrent with lumbar vertebra infection and erosion, brucellosis can easily be misdiagnosed as prostate cancer with bone metastasis.CASE SUMMARYA 45-year-old man complained of recurrent low back pain and fever for 2 wk. Magnetic resonance imaging of the lumbar vertebrae showed abnormal signs at the rear of the L4–5 vertebral body. Serum prostate-specific antigen level was 17.64 ng/mL, and positron emission tomography/computed tomography suggested the possibility of prostate cancer with liver and lumbar metastases. The patient was transferred to our department for further treatment. He experienced repeated bouts of fever and low back pain during hospitalization. Biopsy results indicated prostatitis. There was no significant increase in white blood cell count or procalcitonin levels. The Mycobacterium tuberculosis smear and antibody detection results were negative. Cefoperazone sulbactam was not effective. Blood culture test results were positive for brucellosis, confirming the diagnosis of brucellosis. After oral anti-infection treatment with doxycycline and rifampicin, the body temperature gradually returned to normal, and lumbago improved. After continuous treatment for 6 mo, the patient recovered.CONCLUSIONIn patients with low back pain and fever accompanied by elevated prostate-specific antigen levels and lesions of the prostate and lumbar spine, a detailed medical history and blood and urine cultures should be obtained, and attention should be given to the local epidemic infectious disease situation.     

^99mTc-MDP骨显像在肺癌骨转移诊断中的临床意义

目的探讨肺癌骨转移的临床特点及早期观察骨显像在诊断肺癌骨转移中的临床价值。方法应用99mTc-MDP全身骨显像技术,分析1550例肺癌患者的临床资料和首次骨显像及病理检查结果。结果本实验观察1550例肺癌患者中,肺癌骨转移率为34.8%（540/1550）,其中腺癌41.7%（365/876）,鳞癌23.8%（114/478）,未分化癌为37.1%（33/89）,腺鳞癌26.1%（28/107）。本组460例（85.2%）为多发性明显的放射性浓聚,其余88例（16.3%）呈单发者均经MRI、CT及X线平片证实为骨转移。转移部位分别为：胸部骨68.7%,脊柱39.3%,骨盆32.5%,四肢骨17.8%,颅骨8.8%。结论肺癌患者早期进行99mTc-MDP全身骨显像,对病程分期、治疗方案的选择及预后的评价均有重要的临床意义;99mTc-MDP骨显像肺癌骨转移常见部位是胸部和脊柱,腺癌骨转移率最高。放射性核素骨显像对诊断肺癌骨转移有很高灵敏度。     

肺隔离症八例误诊分析

目的探讨肺隔离症的临床特征、误诊原因及治疗方法,以提高对该病的诊疗水平。方法对2000年8月～2010年10月我院误诊的8例肺隔离症的临床资料进行回顾性分析。结果本组反复咳嗽、咳痰、发热6例,胸痛1例,无症状1例,术前误诊肺囊肿3例、肺脓肿1例、肺癌1例、肺炎性假瘤2例、纵隔肿瘤1例。均行手术治疗,术后病理均明确为肺隔离症。隔离肺切除1例,肺叶切除7例;术后随访3个月～10年无复发。结论肺下叶实性囊性肿块应警惕肺隔离症。行CT增强扫描及后处理技术显示异常的动脉供血血管是诊断肺隔离症的关键。确诊后行肺切除术,术中保持对隔离肺的警惕,灵活处理异常动脉。     

非典型肺结节的螺旋CT征象与病理对照分析

目的探讨螺旋CT在非典型肺结节诊断中的应用价值。方法回顾性分析72例经手术(41例)、穿刺活检(31例)证实的肺结节的CT图像和病理学资料。结果CT表现:浅分叶征(34/72)、形态不规则(50/72)、长毛刺征(10/72)、空气支气管征(2/72)、空泡征(2/72)。螺旋CT拟诊肺癌38例、肺结核瘤22例和肺炎性假瘤12例。病理证实:肺癌30例(其中腺癌16例、鳞癌8例、肺泡癌4例和类癌2例),肺结核30例和肺炎性假瘤12例。诊断符合率:肺癌20/30,肺结核瘤18/30和肺炎性假瘤2/12。72例中,CT诊断正确40例,误诊32例,误诊率44.4%。10例肺癌误诊为肺结核瘤4例(长毛刺、形态不规则)、炎性假瘤6例(形态不规则、长毛刺或空气支气管征);12例肺结核瘤误诊为肺癌8例(浅分叶征)、炎性假瘤4例(浅分叶征);10例炎性假瘤误诊为肺癌(浅分叶征)。结论螺旋CT对非典型肺结节定性诊断较局限,常需穿刺活检确诊。但其对非典型的肺内结节具有很好的定位、密度分辨和形态描述。     

Neck and shoulder disorders in medical secretaries. Part I. Pain prevalence and risk factors

420 medical secretaries took part in a cross-sectional study at examining the prevalence of musculoskeletal disorders as well as the relationship between neck and shoulder pain and possible risk factors. Sixty-three percent had experienced neck pain sometime during the previous year and while 15% had suffered almost constant pain 32% had experienced neck pain only occasionally. Shoulder pain during the previous year had been experienced by 62%, 17% had suffered almost constant pain while 29% experienced pain only occasionally. Fifty-one percent had experienced low back pain. Age and length of employment were significantly related to neck and shoulder pain. Furthermore, working with office machines 5 hours or more per day was associated with a significantly increased risk for neck pain (OR 1.7), shoulder pain (OR 1.9) and headache (OR 1.8). Finally, a poorly experienced psychosocial work environment was significantly related to headache, neck, shoulder and low back pain. The results of this study suggest that work with office machines as well as the psychosocial work environment are important factors in neck and shoulder pain.     

非甾体抗炎镇痛药治疗颈肩腰背痛的临床分析

目的：探讨非甾体抗炎镇痛药(NSAIDs)在临床治疗颈肩腰背痛的合理使用方法，为临床非手术治疗颈肩腰背痛提供理论和实践指导。方法：门诊连续观察同期各种颈肩腰腿痛患者应用非甾体抗炎药的临床疗效，分析不同种类非甾体抗炎药在适应症选择、使用时间、疗效及副作用的不同点。结果：非甾体抗炎药在治疗颈肩腰背痛方面疗效可靠，但均存在有胃肠方面的副作用，其程度不同；不同种类的非甾体抗炎药对于不同患者疗效不同，一种类型的非甾体抗炎药疗效不佳时，更换为其它类型的非甾体抗体药可能有效。辅助胃粘膜保护性药物可提高患者对非甾体抗炎药的耐受性。结论：合理使用非甾体抗炎药是临床治疗颈肩腰背痛的有效方法之一。     

Percutaneous endoscopic transforaminal approach to decompress the lateral recess in an elderly patient with spinal canal stenosis,herniated nucleus pulposus and pulmonary comorbidities

A 70‐year‐old man with severe pulmonary comorbidities was referred to our institution for treatment of a right L5 nerve impingement. He had suffered from spinal canal stenosis and herniated nucleus pulposus (HNP) at the level of L4‐L5 for more than a year and had been treated conservatively. However, the pain could not be alleviated, and his primary care physician scheduled posterior decompression surgery. During this procedure, the anesthesiologist refused to induce general anesthesia because of the patient's very poor pulmonary condition. Subsequently, the patient was referred to us. We used a transforaminal approach with percutaneous endoscopic discectomy, with the patient under local anesthesia. First, herniated nucleus pulposus fragments at the disc level were removed. With a trephine drill, the upper part of the L5 pedicle was removed, which allowed for the extraction of dorsally migrated fragments. Following complete removal of the herniated nucleus pulposus fragments, osseous decompression was performed. The osseous endplate of L5 (anterior part of the lateral recess) was removed to enlarge the lateral recess so that decompression of the L5 nerve root was possible. The patient's lower back pain and right leg pain subsided following surgery. Percutaneous endoscopic discectomy is useful for patients with severe comorbidities as it can be done with local anesthesia.