中国肺动脉栓塞误诊近四年文献分析

目的研究中国目前阶段肺动脉栓塞（PE）误诊状况,旨在调查我国目前PE误诊状况发生的变化。方法通过中国期刊网中国医院知识仓库（CNKI-CHKD）检索2001-2004年发表与PE误诊有关的病例研究报告,对被误诊患者一般情况、治疗及转归、死亡原因、发表文献医院级别、误诊疾病等进行了回顾性调查研究,与1980-2000年的误诊情况作了比较,并调查了1994-2004年每年发表有关PE所有文献与误诊文献篇数变化的趋势。结果（1）经检索后共筛选出误诊文献110篇,累计报告PE误诊患者1540例,误诊时间0．5小时～16年,平均1．86年,涉及临床、诊断技术多个科室。（2）首诊误诊经确诊后进行有效干预（抗凝、溶栓）组,有效率高于误诊后未干预（内科保守治疗）组（OR为11．67,95％CI5．861-23．249）,病死率低于未干预组（OR为0．19,95％C10．084-0．412）。未干预组死亡原因主要为猝死、休克难以纠正等,干预组死亡原因为猝死、脑出血、休克等。（3）省级医院、地市级医院、县级医院、乡镇厂矿医院等报告误诊文献篇数与误诊病例数量分别为37篇547例（33．6％、35．5％）、43篇671例（39．1％、43．6％）、23篇265例（20．9％、17．2％）、3篇34例（2．7％、2．2％）。（4）1994--2004年发表有关PE的文献与误诊文献篇数逐年增多,平均每年递增分别为26．6％、9．1％。（5）被误诊疾病多达70余种,前4位依次是：冠心病449例次（26．8％）、肺炎217例次（12．9％）、充血性心力衰竭142例次（8．5％）、胸膜炎114例次（6．8％）。结论（1）误诊原因与首诊医师对病情不能充分认识有关,被误诊的患者若不能尽快确诊而进行有效干预则严重威胁其健康。（2）与1980-2000年比较,PE误诊疾病次序已有所变化,但冠心病与肺炎仍占据误诊疾病的前两位,应加强PE与两种疾病问的鉴别诊断能力。（3）中国医生对PE及其误诊的重视程度已有明显提高,但基层医院医师的认识水平有待进一步加强,应加强我国临床医师对肺栓塞知识继续教育普及的力度．我国防治PE的仟备仍仟萤而诺沅．     

慢性栓塞性肺动脉高压的误诊分析

目的：为提高对慢性栓塞性肺动脉高压（CTEPH）的认识和诊断。方法：回顾性分析72例慢性栓塞性肺动脉高压患者中,65例在院外被误诊为其它心肺疾病的临床资料。结果：院外误诊率为90．28％,共误诊97例次（有的患者曾误诊多种疾病）,误诊的情况为原发性肺动脉高压22例次（22．68％）、冠心病18例次（18．56％）、先天性心脏病16例次（16．49％）、心肌炎10例次（10．31％）、心肌病9例次（9．28％）、风湿性心脏病5例次（5．15％）、心包炎2例次（2．06％）及肺部疾病15例次（15．46％）。结论：CTEPH误诊率极高,临床医师应提高对CTEPH的认识,减少误诊。     

肺栓塞的诊断进展

肺栓塞（pulmonary emblism，PE）是内源性或外源性栓子堵塞肺动脉或其分支引起肺循环障碍的临床和病理生理综合征，它包括肺血栓栓塞症、脂肪栓塞综合征、羊水栓塞、空气栓塞等。由于PE突发率高、易误诊和漏诊等原因，死亡率极高，在欧美等西方国家处于死因的第三位，我国最新统计资料显示：我国每年约60万人患PE占死因的第四位。因此，采取有效的方法早期诊断PE具有非常重要的意义。现就肺栓塞的诊断做一综述。     

肺动脉栓塞7例误诊分析

肺动脉栓塞 (PE)为一种常见的心肺疾病 ,在美国每年发病人数为 65 0 0 0 0人 ,约占急性心肌梗死发生率的 1/2 ,是脑卒中发生事件的 3倍 ,但此病误诊率较高 ,容易贻误抢救时机 ,现将7例曾误诊为其他疾病的PE分析如下。1　临床资料1.1　一般资料　确诊为PE的 10例病人曾被误诊者有 7例 (男5例 ,女 2例 ) ,年龄 3 3岁～ 76岁 ,平均年龄 5 1.6岁。PE确诊依据 :①选择性肺动脉造影示肺动脉阻塞或充盈缺损 ;②同位素肺通气灌注扫描 :病灶部位血流缺失 ,而通气正常或接近正常。1.2　误诊疾病　 7例曾被误诊的PE病人中 ,被误诊为肺炎 1例 ,胸膜…     

肺动脉栓塞136例临床分析

肺动脉栓塞（PE）是肺动脉及其分支栓塞引起的肺循环障碍的临床及病理生理综合征。因PE症状复杂多变、诊断困难，临床上常引起误诊误治。我院心内科自2002年以来先后诊治PE患者136例，现对其诊治情况报告如下。     

胰岛素瘤误诊原因探讨和处理对策（附71例报告）

目的：分析胰岛素瘤误诊原因，探讨避免误诊、误治的策略。方法：对1990年1月至2001年9月北京协和医院收治的71例胰岛素瘤患的临床资料进行回顾性分析。结果：本组患从发病到确诊时间为3个月－30年，平均4．24年，1年内获得确诊17例，占23．9％。93％的患有被误诊的病中，最常见的误诊原因分别为反应性低血糖（38％）、癫痫（23．9％）、颅内病变（21．1％）和脑血管病（12．6％）；4．2％的患被误诊为精神病。在获得确诊时，54．9％的患有不同程度的记忆力下降，智力减退或反应迟钝。结论：Whipple三联征和胰岛素／血糖（I／G）＞0．3是胰岛素瘤定性诊断的主要依据。提高对胰岛素瘤的警惕性，合理应用辅助检查，有助于减少误诊。对定性诊断明确的患，无论能否获得定位诊断，均应及早手术探查，以免延误治疗。     

老年肺栓塞的诊断进展

肺动脉栓塞（pulmonary embolism,PE）,是内源性或外源性栓子堵塞肺动脉或其他分支引起肺循环障碍的临床和病理生理综合征,是许多疾病的一种严重并发症,发病率较高.由于其病因的复杂性、临床表现及常规检查的非特异性,临床误诊、漏诊及病死率较高,据报道在现代先进诊断技术高度发展的今天,PE的误诊率仍在70%以上[1],若诊疗及时,病死率仅为2%～8%[2].因而,对PE做出及时诊断尤显重要.     

主动脉夹层动脉瘤误诊64例分析

目的了解主动脉夹层动脉瘤（AD）误诊的现状，提高对AD的诊断认识。方法收集我院2001年以来误诊为其他疾病的主动脉夹层动脉瘤的住院患者64例，对被误诊的64例AD患者的误诊疾病、临床表现、辅助检查等进行了回顾性调查研究。结果AD患者临床症状多样。疼痛症状发生率最高（85．1％），以胸背痛居首，腹痛为其次。误诊疾病达12种。前5类疾病依次为冠心病26例次（40．63％）、急腹症11例次（17．19％）、中枢神经系统病变3例次（4．69％）、尿路结石3例次（4．69％）、风心病例3次（4．69％）。结论AD的临床表现复杂，不具备特异性。AD的误诊率高，误诊的疾病种类繁多。对胸痛、周围动脉阻塞征象，伴或不伴高血压的患者，应提防AD的可能。结合影像学检查，可提高诊断率。     

肺血栓栓塞症十例临床病理分析

目的：为帮助临床进一步认识肺血栓栓塞症（PTE），对10例PTE进行临床病理分析。方法：收集近十年来的8例PTE尸检资料及2例外科肺血栓活检资料与临床进行对照分析。结果：10例PTE中，年龄3．5－72岁（平均33．3岁），来自先天性心脏病4例，心、肺恶性肿瘤各1例，风湿性心脏病1例，下肢静脉炎1例，另2例肺动脉血栓来源不明。10例中仅2例无心肺血管原发疾病，其临床PTE诊断与病理符合，余8例均未被临床诊断。结论：从本资料分析原有心血管病、心、肺肿瘤及合并肺炎（肺脓肿）患，其PTE常被临床漏、误诊。多争取病理检查，对临床医生进一步认识PTE会有帮助。     

我国青年肺癌误诊综述

目的了解我国青年肺癌误诊的现状。方法通过中国生物医学文献数据库（CBMd isc）检索2001年1月至2009年12月发表的与青年肺癌误诊有关的病例研究报告21篇,对被误诊的835例青年肺癌患者的误诊疾病、临床表现、病理类型及诊断方法等进行了调查研究。结果青年肺癌患者被误诊疾病达30余种,前三位依次是肺结核417例次（49.7%）、肺炎187例次（22.3%）、结核性胸膜炎78例次（9.3%）。结论对青年肺癌认识不足,容易误诊,应予以重视。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.