诊断学教学质量监控与管理体系的构建

诊断学是医学的基础与桥梁，高质量的诊断学教学是培养合格医学人才的保证。要提高诊断学教学质量，必须加强对教学过程的内部监控，建立更加系统、科学、高效的质量管理体系，从教学管理水平、教学管理人员及教师素质、学生素质、教学条件、教学过程、教学质量督导系统、教学信息评估反馈系统等各个环节加强管理。     

建立现代化诊断学模拟实验中心的实践

目的探讨诊断学教学改革新方法的效果。方法建立现代化诊断学模拟实验中心:检体诊断模拟实验室、器械诊断模拟实验室、实验诊断示教室的教学新方法与传统的教学方法进行比较。结果改革后学生学习兴趣增加、考试成绩明显提高,与改革前比较差异有显著性(P<0.05)。结论建立现代化诊断学模拟实验中心,加强学生实际操作技能,势在必行。     

Serum procalcitonin (PCT): a valuable biochemical parameter for the post-mortem diagnosis of sepsis

The aim of this prospective study was to investigate whether serum procalcitonin (PCT) can be used as a post-mortem marker of sepsis and to determine whether this biochemical parameter can be employed in the forensic elucidation of death due to sepsis. At least three blood samples were collected between 0.3 and 139 h post-mortem from sepsis-related fatalities (n = 8) and control individuals (n = 53, where death was due to various natural and unnatural causes). Additionally one ante-mortem blood sample was collected shortly before death from the patients in the sepsis group. In the sepsis group, serum PCT concentrations, determined by using an immunoluminometric assay, were elevated in all patients for the whole observation period, whereas in the control group serum PCT was not detectable in 94% of the cases. Measurement of PCT levels seems reasonable until at least approximately 140 h postmortem, depending on the ante-mortem levels. A linear regression model is presented that allows the serum PCT concentration of an individual at the time of death to be estimated on condition that at least two positive post-mortem PCT values have been determined. Ante-mortem PCT values correlated well with the predicted PCT values at the time of death in the sepsis group using the standardized PCT logarithms. According to the results of the present study, PCT is a valuable biochemical parameter for the post-mortem discrimination between sepsis and underlying non-septic causes of death. Received: 29 March 2000 / Accepted: 12 June 2000     

Survey on influenza laboratory diagnostic and surveillance methods in Europe

The survey was undertaken by ESWI in order to investigate the comparability of the laboratory diagnostic methods and the influenza surveillance systems used in 24 European countries. The results indicate considerable consensus in the general approaches to collection and use of clinical specimens, rapid diagnostic techniques, virus isolation techniques in eggs or/and MDCK cell lines, virus identification and use of inhibition of hemagglutination (IHA) and complement fixation (CF) tests for serological diagnostics. However, the details of the techniques used are somewhat heterogeneous: antigen detection methods (immunofluorescence versus immuno adsorbent assay), isolation methods (eggs versus tissue culture), reagents (locally produced, WHO, commercial) are not always equivalent and results are therefore not really comparable. Some of these discrepancies are due to a lack of resources or a lack of priority for influenza in the country. The greatest differences between individual countries exist in the epidemiological part of surveillance programmes. The mode of collection of influenza related mortality and absentism from work varies considerably in different countries. These findings indicate the need to harmonize viral procedures and surveillance systems in European countries in order to improve validity and comparability of results and as a prerequisite for early information on influenza etiology and spread.     

Klinik und Diagnostik des „Anal- und Rectumcarcinoms“

Ohne Zusammenfassung

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Invasive candidiasis in immunocompromised hospitalized patients

The frequency of infections by Candida species is increasing worldwide, with candidemia representing the fourth most common bloodstream infection in the U.S. The risk of infection is especially high in the immunocompromised, hospitalized patient. The treatment of and prophylaxis for Candida infection have led to the emergence of resistant species and the acquisition of resistance in previously susceptible species. Current therapeutic options include amphotericin B and its lipid compounds, fluconazole, itraconazole, voriconazole, and caspofungin. Research is focusing on better diagnostics and the evaluation of strategies such as prophylaxis in high-risk hosts and pre-emptive therapy.     

The importance of non-invasive genetic analysis in the initial diagnostics of Alport syndrome in young patients

Alport syndrome is an important hereditary disorder characterized by nephritis and sometimes accompanied by impairment or loss of vision and hearing. The most common form of Alport syndrome is an X-linked dominant trait that has been associated with the gene COL4A5, one of the six types of IV collagen genes. More than 300 different mutations have been identified in the COL4A5 gene, and appear randomly along the whole gene. Three novel mutations, G198E, G3189D and G669R, were found in 5 young patients from 3 different Slovenian families. On the basis of the results of our study and the existing national register of Alport syndrome patients, we demonstrated that non-invasive methods, such as the genetic analysis of collagen genes, particularly in the case of young patients with undefined clinical features, may be of great importance and could diminish the need for invasive skin and renal biopsy. Our study showed the importance of molecular genetic data for the purpose of providing quick and precise diagnoses for affected family members and their offspring, particularly small children.M. lajpah and A. Megli contributed equally to this work     

Determining reference ('normal') limits in medicine: an application

We provide an account of a study to assess reference limits for eight routine laboratory determinations at the Academic Hospital of the Free University, Amsterdam and emphasize methodological issues rather than results. We argue that reference limits have use mainly in the first phase of the diagnostic process. Reference and target populations should be grossly comparable, and therefore patients (after slight selection) could well serve as references. However, we found major differences between in- and out-patients, so we suggest that this factor, together with age and sex, be taken into account. To arrive at reliable limits, the size of the reference sample should be at least 100. Laboratory reports should provide percentiles, which enable a more flexible decision than do fixed limits.     

Paralysis of the femoral nerve following totally extraperitoneal laparascopic inguinal hernia repair

Totally extraperitoneal preparation (TEP) of an inguinal hernia is an established method of treating inguinal hernias associated with an acceptable complication rate (2–12%) and low rate of recurrence (0–3%). This is the first reported case of sensorimotor paralysis of the femoral nerve following the complete endoscopic mesh treatment of a primary inguinal hernia to the left side. Following a discussion of the necessary diagnostic and therapeutic steps, traumatic postsurgical paralysis of the nerve as well as spontaneous paralysis of the femoral nerve are discussed. The prognosis is positive given the lack of macroscopic evidence of any direct damage to the nerve.