膀胱癌常规超声误、漏诊原因分析

目的分析经腹超声检查膀胱癌的误、漏诊原因，并探讨避免的方法对策。方法对145例经手术病理证实的膀胱癌进行回顾性分析。结果超声诊断膀胱癌准确率83．4％（12l／145），漏诊发生率9．7％（14／145），误诊发生率6．9％（10／145），漏诊率与误诊率的差别无显著性（P〉0．5）。肿瘤体积小、位于膀胱前壁或顶部和膀胱不充盈为漏诊的主要原因。而血块、结石、前列腺增生组织、良性肿瘤为误诊对象。在对误、漏诊原因分析的同时还总结出了经验教训及鉴别要点。结论常规超声诊断膀胱癌是一种非常好的方法，但存在一定的误、漏诊率，应结合膀胱镜等多种方法综合检查以减少或避免误、漏诊现象。     

老年甲状腺功能亢进误诊62例分析

目的：为探讨老年甲状腺功能亢进（以下简称甲亢）早期误诊原因，以期提高诊断率。方法：对62例老年甲亢首发症状及早期临床资料分析。结果：98例患者中62例患者曾被误诊，误诊率为63．300，误诊疾病主要为心血管、消化系统疾病分别为48．4％、46．8％，占总误诊率的95．2％，其次为糖尿病、植物神经紊乱、帕金森、周期性麻痹。结论：老年甲亢临床症状不典型，容易被误、漏诊。为了提高广大临床医生，尤其是基层医务工作者，对老年甲亢的认识和重视，应注意甲状腺功能。减少误、漏诊率。     

椎管内髓外肿瘤19例误漏诊分析

目的探讨椎管内髓外肿瘤误漏诊的原因。方法分析我院2000年1月—2012年12月收治并误漏诊的19例椎管内髓外肿瘤的临床资料。结果本组早期多表现为根性痛,疼痛位于腰骶部13例,下肢7例,颈肩臂3例,胸腹部1例,部分伴肢体麻木、感觉减退、肌力减退及病理反射阳性。本组误诊14例,漏诊5例。误诊为肌肉劳损5例,腰椎间盘突出症4例,颈椎病3例,腰椎管狭窄2例。5例漏诊者因合并疾病行腰椎间盘摘除术或椎管减压术,4例术中发现椎管内髓外肿瘤,另1例术中漏诊,复诊时行MR检查确诊。14例按误诊疾病治疗效果不佳,行MR检查确诊。本组均行肿瘤摘除术并经病理证实诊断,术后恢复良好。结论椎管内髓外肿瘤早期临床表现不典型,易误漏诊。重视病史采集、仔细查体、及早行MR等影像学检查是减少误漏诊的关键。     

椎管内肿瘤CT误诊浅析

椎管内占位性病变以腰腿痛为主要表现时 ,易被临床及影像检查忽视而漏诊和误诊。本文收集我院 1994～1999年的 2 0 0例腰腿痛病例 ,均行ＣＴ及ＭＲＩ检查 ,其中4 2例 (2 1 0 % )椎管内肿瘤ＣＴ检查漏诊或误诊。现将误诊原因及影像学检查手段作一分析和评价。1　临床资料1 1　一般资料　 4 2例中 ,男 2 6例 ,女 16例 ;年龄 17～75岁 ,平均 4 6岁。病史半个月～ 2年。1 2　临床表现　患者以腰腿痛为主要表现 ,其中单侧腰腿痛 34例 ,双侧腰腿痛 8例 ,下肢麻木及痛觉减退 15例 ,会阴感觉部分减退 11例。病理反射阳性 9例 ,腰椎棘突旁压痛或叩痛 …     

超声检查将其他肺部疾病误诊为胸腔积液原因分析

目的探讨超声检查易误诊为胸腔积液的疾病类别及其临床特点,分析超声误诊的原因并提出防范对策。方法对我院2006年1月一加u年10月首次超声检查误诊为胸腔积液,后经胸部CT或手术病理确诊为其他疾病的34例相关声像图资料进行分析总结。结果本组34例经胸部CT或手术病理确诊为肺实变11例,胸膜肥厚9例,肺大泡5例,肺血管瘤5例,胸壁结核脓肿向胸腔内突4例;其中初级医师误诊18例（52．94％）,中级医师误诊13例（38．24％）,副主任医师误诊3例（8．82％）。结论胸腔积液病因复杂,临床医师尤其是初级医师通过二维（黑白）超声无法对疾病进行定性诊断时,应及时行彩色多普勒超声、胸部cT或胸腔穿刺等检查,以免误漏诊。     

1型巨肌酸激酶血症误漏诊情况分析

目的调查研究1型巨肌酸激酶（macro—creatine kinase type 1,MCK—1）血症误漏诊现状。方法2002年4月-2010年5月我院常规检测生化全项或心肌酶谱的血清标本中筛查出经CK同工酶琼脂糖凝胶电泳分析确诊MCK-1血症35例,收集并整理其临床资料,对误漏诊情况进行分析。结果35例MCK-1血症中,共误漏诊31例（88．6％）,其中漏诊18例（51．4％）,误诊13例（37．2％）;误诊病例中以误诊为急性心肌梗死、肌肉疾病和2型巨肌酸激酶（MCK-2）血症较多见。结论MCK．1血症误漏诊情况临床上较常见,各科室医生尤其是急诊科和心内科医生应加强对本症的关注,以提高诊治水平。     

超声诊断乳腺癌的漏诊和误诊分析

目的：探讨超声诊断乳腺癌的漏诊和误诊原因,以提高超声诊断乳腺癌的准确性。材料和方法：将582例乳腺癌患者的超声、临床和病理资料进行分析,对超声漏诊和误诊原因进行归纳和总结。结果：超声检查的发现病变562例（96．56％）。漏诊20例（3．44％）,其中导管内癌10例,浸润性导管癌6例,浸润性小叶癌3例,Paset病1例。误诊26例（4．47％）,其中误诊为纤维腺瘤14例,囊性增生9例,导管内乳头状瘤2例,叶状肿瘤l例。结论：超声诊断乳腺癌具有较高的准确性,掌握正确的检查方法、合理的调节仪器和分析声像图．有助于减少漏诊和误诊的发生。     

脊柱爆裂骨折的CT与X线平片诊断对照分析(附105例报告)

目的：进一步提高CT和X线平片对脊柱爆裂骨折诊断价值的认识。方法：收集经CT检查确诊为脊柱爆裂骨折而线平片诊断为单纯压缩性骨折或未见骨折者共105例进行对照分析。结果；因X线平片无典型征象而误诊33例，由于对典型征象缺乏认识而误诊53例，由于投照因素漏诊19例。结论：X线平片对脊柱爆裂骨折的误诊、漏诊率较高，提高认识水平和投照质量可减少误、漏诊，CT能提高脊柱爆裂骨折的诊断准确率并显示椎管的狭窄程度，有利于临床及时正确的处理。     

MRI在椎管内肿瘤诊断中的应用价值

目的：探讨MRI在椎管肿瘤诊断中的应用价值。方法：对我院45例椎管肿瘤的MRI征象进行回顾性分析。结果：45例肿瘤中，室管膜瘤6例，星形细胞瘤4例，神经鞘瘤10例，神经纤维瘤4例，脊膜瘤8例，转移性肿瘤9例，巨细胞瘤1例，囊肿3例。诊断定位准确率100％，定性诊断准确率95．5％，2例误诊。结论：MRI检查对椎管内肿瘤的定位及定性诊断有较高的价值。     

50例椎管神经鞘瘤MRI分析

目的分析椎管内神经鞘瘤的MRI表现,提高其术前诊断准确率。方法回顾性分析经手术病理证实的50例椎管内神经鞘瘤的MRI表现。男25例,女25例,神经鞘瘤49例,恶性外周神经鞘膜瘤1例。全部病例均行MR平扫及增强。结果50例均位于脊髓外硬膜下,初次MRI诊断正确44例（88％）,漏诊及误诊各3例（6％）。漏诊的3例均位于下腰段,1例为直径仅5mm的神经鞘瘤,2例瘤体完全囊变,菲薄的囊壁淹没在脑脊液的信号中;误诊的3例中,误诊为神经纤维瘤1例,误诊为室管膜瘤1例,另1例恶性外周神经鞘膜瘤术前误诊为良性神经鞘瘤。结论MRI表现典型的椎管内神经鞘瘤诊断较容易,表现不典型者易误诊,微小肿瘤以及完全囊变的肿瘤易漏诊,需仔细观察。     

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.     

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.     

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.     

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.