甲状腺癌26例误诊误治原因探讨

目的探讨甲状腺癌误诊误治的原因,以及避免误诊误治的方法。方法回顾1997~2004年68例甲状腺癌中误诊的26例临床资料,结合文献进行分析。结果误诊率达38.2%(26/68)。误诊病例中,术前CT检查8例、细针穿刺细胞学检查3例,术中快速冰冻切片检查5例。再手术18例。结论甲状腺癌误诊率高,且常被误治。对甲状腺肿块术前未行穿刺细胞学检查和术中未行快速冰冻切片是甲状腺癌误诊误治的最主要原因。常规术前细胞学检查和术中冰冻切片检查,有利于确诊及正确的术式选择。     

阑尾周围脓肿误诊为卵巢肿瘤行手术治疗的经验教训

目的提高对阑尾周围脓肿的诊断与鉴别诊断水平。方法回顾分析26例阑尾周围脓肿误诊为卵巢肿瘤行手术治疗的原因及预防措施。结果26例患者术前均误诊为卵巢肿瘤行手术治疗,术中发现为阑尾周围脓肿行脓肿引流或阑尾切除治愈,其中4例患者术中损伤肠管行肠修补、局部引流而治愈（1例并发肠瘘）。结论阑尾周围脓肿误诊为卵巢肿瘤而手术,易导致严重并发症。术前仔细询问病史,细致体格检查,全面分析辅助检查结果,认真做好诊断和鉴别诊断,能减少或避免阑尾周围脓肿的误诊误治。     

腹壁子宫内膜异位症31例临床分析

目的:探讨腹壁子宫内膜异位症的临床特点、治疗方法和预后。方法:回顾性分析1999~2007年本院收治的31例腹壁子宫内膜异位症病例的临床资料,足月剖宫产史26例,就诊年龄(28.8±9.2)岁,发病时间为术后3个月~6年,均有程度不同的经期切口瘢痕处胀痛症状。行手术切除26例,药物保守治疗5例。结果:行手术切除病灶的26例患者术后无一例复发,切除病灶直径平均4.0 cm,显著大于术前扪诊和超声测量的1.0~2.0cm(P<0.01)。医源性内膜种植引起切口异位症占0.05%。31例腹壁子宫内膜异位症治疗后随访,药物保守治疗者停药后均有不同程度的症状反复。结论:手术后腹壁子宫内膜异位症的发生与手术引起的医源性内膜种植有关,治疗首选手术,B超用于术前测量病灶大小及病灶的浸润范围。复发后可再次手术。腹壁子宫内膜异位症治疗最重要的在于预防。     

腹腔镜在阑尾炎误诊中的作用

3例误诊为阑尾炎患者,2例经腹腔镜探查,很快证实1例为“胃溃疡穿孔”,1例为“急性胰腺炎”,经治疗治愈,1例院外转入已行阑尾切除术患者,因延误诊断及治疗导致死亡。总结经验教训：一是加强术前对患者病情的诊断,包括详细询问病史,仔细全面查体,积极完善相关辅助检查;二是主张在病情允许情况下尽可能采用腹腔镜手术,有利于探查除阑尾之外的其他疾病,尽可能减少误诊及误治给患者带来的痛苦。     

不典型甲状腺功能亢进症误诊31例

甲状腺功能亢进症（简称甲亢）临床表现多样，若首诊医生经验不足，会导致误诊误治现象发生。本文总结自2002年以来我院首诊或转诊收治的不典型甲亢31例，分析了首诊误诊常见原因。     

异位妊娠误诊分析82例

现将我院近 1 0年收治的异位妊娠 1 0 2 6例中的误诊病例 82例作一回顾性总结 ,分析其误诊原因及应吸取的教训 ,探讨如何降低误诊率。1　临床资料本组 82例均为首诊后一直以误诊疾病进行治疗 ,直至手术时方诊断为异位妊娠者 ,包括院外误诊5 1例 ,院内误诊 31例 (其中内、外科误诊 2 2例 )。患者年龄 2 0～ 42岁 ,其中 2 2～ 35岁 74例 ,占 90 .2 %。有人工流产史 5 8例 ,置宫内节育器 30例 ,不孕史1 1例 ,慢性盆腔炎史 2 5例 ,重复异位妊娠 5例。停经 32～ 65天 70例 ,不规则阴道出血 5 6例 ,腹痛 71例 ,休克 31例。75例测尿 HCG,70例阳性…     

13例阑尾肿瘤误诊的原因探讨

目的:探讨阑尾肿瘤的误诊原因和诊治意义。方法:通过对我院1989年3月~2009年1月收的13例阑尾肿瘤病例,并结合文献复习、分析和探讨。结果:本组13例,术前无1例确诊,误诊13例。全部行手术治疗,经术后病理组织学检查证实,误诊原因包括患者的疏忽以及医务工作者对其认识不足和知识面窄等。结论:对阑尾肿瘤的误诊误治以至贻误病情可造成极为不良的后果,及早诊断意义重大。     

异位妊娠50例误诊原因分析

目前异位妊娠发病率呈明显上升趋势犤1犦。由于异位妊娠的临床表现和体征呈多样化,易与多种疾病相混淆,误诊率极高,异位妊娠的误诊导致误治,甚至可因大出血导致病人死亡犤2,3犦。本院从1995年1月～2001年12月收治异位妊娠272例,对其中50例误诊病例进行分析,探讨其误诊原因及减少误诊的对策。1临床资料1.1一般资料本文误诊是指患者首诊后一直以误诊疾病进行治疗,直到手术时方诊断为异位妊娠者。包括院内误诊12例,院外误诊38例。患者年龄19～42岁,其中2l～36岁44例,占88%。有人工流产史38例;宫内置节育器6例;不孕2例;慢性盆腔炎4例;停经史40例…     

老年性甲状腺功能亢进症合并心脏病26例误诊分析

自1996年1月~2004年12月我院共收治老年性甲状腺功能亢进症合心脏病(甲亢心)患者31例,其中26例误诊误治,误诊率高达85%,为提高对本病的认识,现分析如下。1临床资料26例误诊患者中男2例,女24例,年龄50~70岁。就诊前误诊时间3个月~3年,就诊后误诊时间5~15天。误诊为冠心病20例,其中10例合并心动过速,5例合并心力衰竭,3例合并心绞痛,2例合并心房纤颤;4例误诊为心肌病,2例误诊为风湿性心脏病。2讨论甲亢心是由甲亢直接引起的心脏改变,表现为心脏扩大,心力衰竭,心律失常等[1]。随着人口的老龄化,甲亢心在老年人中发病有增加趋势,大约占甲亢患者的…     

胰腺损伤7例的误诊误治分析

我院自1987年～1997年共收治胰腺损伤21例,其中误诊误治7例,占同期胰腺损伤病例33％（7／21）。现将误诊误治情况分析如下。16床出符1.l一般情况：本组患者共7例,男5例,女2例,年龄15岁～66岁。1.2伤因及损伤部位：其中车祸2例,钝器击伤1例,刀刺伤1例,火器伤三例,手术误伤2例,欲头部挂裂伤4例,胰体部挫裂伤1例,胶体尾部挫裂伤2例。1.3主要症状及检查方法：本组患者伤后立即出现腹痛及腹膜刺激征者4例,伤后72小时始出现腹痛者1例,血清及尿淀粉酶升高者3例,术前行B起检查3例,腹腔穿刺3例。1.4误诊误治情况：术前误诊1例,手术探查记诊2例,术式…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.