Pulmonary pattern in systemic vasculitis: granulomatosis,lung cancer or both?

As clinical manifestations of systemic vasculitides share many common features with other conditions, the rate of diagnostic errors and delayed diagnoses is high. Hence we performed an analysis of the available data regarding misdiagnosis of vasculitis as lung cancer and vice versa, as well as coexistence of vasculitis and lung cancer. The present case-based review highlights the diagnostic challenges encountered when granulomatosis with polyangiitis (GPA) mimics lung cancer. The importance of a multidisciplinary team approach to patients with pulmonary involvement and multisystem manifestations is essential for appropriate planning of further diagnostic steps and for minimizing the delay in correct diagnosis and treatment. In the present case, although computed tomography raised suspicion for lung cancer, further biopsies and laboratory screening for systemic vasculitides rejected malignancy and confirmed the diagnosis of GPA.     

咽、喉部结核30例临床分析

目的探讨咽、喉部结核的临床特征和诊断。方法对30例咽、喉部结核病的临床资料进行回顾性分析。结果30例咽、喉部结核病人均有不同程度的咽痛,咽、喉部呈增殖型改变15例,坏死溃疡7例,局部肿胀10例,结核中毒症状6例。结论咽喉结核临床表现不具特异性,易误诊。X线摄片、局部活检、痰液涂片或培养同时检测可提高诊断率。     

Pitfalls of chromosome analysis

ABSTRACT In order to perform precise chromosome analysis, we have to have enough knowledge of cytogenetics, refined techniques and good communication between clinicians and cytogeneticists. This short note shows several examples of easily misdiagnosed chromosome abnormality and several suggestions for precise cytogenetic diagnosis.     

药物性肝病的误诊原因分析

目的：为提高对肝脏疾病的诊断水平。方法：采用回顾性调查的方法，对85例药物性肝病误诊原因进行分析。结果：误诊为病毒性肝炎者70例，胃肠炎者5例，胆系感染者3例，上呼吸道感染者3例，肿瘤复发者2例，糖尿病加重者2例。结论：任何时候都要考虑到药物性肝损害的可能。     

骨盆骨折并单纯性腹腔内出血的误诊及急救处理教训

目的总结骨盆骨折并单纯性腹腔内出血误诊经验教训及急救处理。方法对8例骨盆骨折并单纯性腹腔内出血的伤因、诊断、急救方法选择进行回顾性分析。结果骨盆骨折并单纯性腹腔内出血与伤因及搬运不当致骨折移位、再移位密切相关；与骨折部位也关系密切；骨盆骨折并单纯性腹腔内出血常易误诊为腹腔内脏合并伤而行剖腹探查术时确诊，腹膜后血肿探查止血，术中、术后死亡率高。结论骨箍骨折并单纯性腹腔内出血易误诊为腹内脏器伤，救治困难，死亡率高。     

肺癌骨转移所致腰腿麻痛的误诊原因(附1例报告并文献复习)

目的分析肺癌骨转移引起腰腿痛症状导致误诊的原因及教训。方法对1例误诊为腰椎间盘突出症、腰臀部慢性软组织损害的肺癌骨转移致腰腿痛患者的诊疗过程结合文献进行综合分析。结果肺癌骨转移所致腰腿麻痛症状是因受累椎体发生溶骨性破坏或楔形变,对应椎管位置狭窄,肿瘤侵犯骨皮质或软组织肿块压迫刺激脊髓和神经根而引起,本病误诊的主要原因是病史询问不详,查体简单、粗疏,未做针对性强的影像学检查。结论仔细询问病史,认真查体,与早期行针对性强的影像学检查相结合,可有效降低误诊率。     

Misdiagnosis in epilepsy: a review and recognition of diagnostic uncertainty

The diagnosis of first seizure or epilepsy may be challenging and misdiagnosis can occur. Studies carried out in various settings have reported misdiagnosis rates of between 4.6% and 30%. Misdiagnosis can lead to serious consequences including driving and employment restrictions and inappropriate treatments. Most studies focus on ways of reducing misdiagnosis. However, in some cases, it may be difficult to make a definite diagnosis at initial presentation. This is because of a number of reasons including overlapping clinical features with other conditions, inadequate available history and limitations of investigations. Consequently, diagnostic uncertainty is inevitable in epilepsy, although few studies acknowledge this. In this paper we review the literature on misdiagnosis rates, analyse reasons for misdiagnosis and consider limitations of available investigations. We propose that diagnostic uncertainty in epilepsy should be more widely acknowledged and addressed, and that this may reduce misdiagnosis rates.     

Presumed toxoplasmic papillitis

Six patients with ocular toxoplasmosis are described whose only active site of inflammation was at the optic nervehead. These patients presented with severe papillitis, vitreous inflammation, and sector or nerve fiber bundle field defects. Because of the papillitis and the absence of other typical foci of retinitis to suggest toxoplasmosis in these patients, the initial diagnoses were usually incorrect. These cases are presented to familiarize ophthalmologists with this unusual cause of papillitis.     

PERCE THE PERMISSIVE PATHOLOGIST: A CAUTIONARY TALE OF ONE WHO MISDIAGNOSED A PSEUDOSARCOMA,KILLED THE PATIENT AND WAS FOUND OUT

Perce, a promising young trainee pathologist, correctly recognizes a biopsy of a benign pseudosarcoma but his diagnosis is overruled by the less well read Head of Pathology. Acting under instructions from his Chief, Perce knowingly and without protest ‘signs out’ this benign condition as a sarcoma. The surgeon accepts the diagnosis without question and performs radical surgery, which is complicated by postoperative haemorrhage from which the patient dies. The Coroner orders a review of the slides and the misdiagnosis is discovered. Perce's defence that he did as he was told is rejected; he is forced to quit pathology and becomes an administrator. This unfortunate tale, which is related in verse, is intended to stress the importance of such benign but uncommon pseudosarcomas as nodular fasciitis, proliferative myositis, myositis ossificans, postoperative spindle cell nodule, pseudo- sarcoma of the bladder and juxta-articular myxoma. The poem also implies that surgeons should not carry out radical surgery based on an uncommon pathological diagnosis without checking on the adequacy of consultation and informed review of the sections.     

儿童肺炎漏误诊原因分析——附65例尸检病理和临床资料

目的通过对65例尸检患儿病理与临床资料的总结分析,探讨儿童肺炎误诊、漏诊的原因。方法回顾性分析1990年至2008年间尸检病例中经临床或病理诊断为肺炎的65例患儿资料,按肺炎在病理诊断与临床诊断中的符合情况进行分组,分别对各组病例的临床表现、影像学检查、病理资料进行对照分析。结果临床与病理均诊断为肺炎者25例,临床未诊断为肺炎而病理诊断为肺炎者27例,临床诊断肺炎而病理否定者13例,肺炎正确诊断率仅为38.5%(25/65)。儿童肺炎的临床表现常不典型,与脓毒症、颅内感染、肺结核鉴别困难,各组患儿症状、体征相似;肺炎致死病例常合并其他基础疾病,以肺炎为主要致死病因者占13.5%(7/52),以其他疾病为主要致死病因者占7.7%(4/52),绝大多数由包括肺炎在内的多种疾病共同致死。仅56.9%(37/65)的患儿完善了肺部影像学检查。病理类型以支气管肺炎和间质性肺炎最为常见。结论儿童肺炎诊断须全面而综合,在临床工作中,除积极治疗肺部感染外,尚需重视其原发病和并发症。