广州管圆线虫病误诊为结核性脑膜炎2例报告并文献复习

目的探讨广州管圆线虫病容易出现误诊的原因及诊断方法。方法对2例误诊为结核性脑膜炎患者的诊疗过程结合文献综合分析。结果2例病人均因未询问出病史、第1次化验时血嗜酸性粒细胞分类正常、脑脊液化验与结脑类似而误诊。结论仔细询问病史、认真查体,临床症状与影像学检查结合血特异性抗体检测可有效地避免误诊、误治。     

49例肺炎误诊肺结核分析

目的探讨肺炎误诊肺结核的原因及其对策。方法对49例肺炎误诊肺结核患者进行分析。结果临床表现为午后低热57．1％,咯血32．7％,盗汗28．6％;X线胸片病变位于上叶尖后段、下叶背段71．4％;白细胞总数在4．0～10．0×10^9／L之间占69．4％,结核菌素纯蛋白衍生物（PPD）皮试阳性61．2％,培养阳性18．4％。结论误诊的主要原因：肺炎临床症状不典型;胸片、血常规检查与肺结核相似;对结核菌素的诊断价值估计过高和细菌培养阳性率过低。防治对策：重视病原学检查、血清抗体检测和临床资料的综合分析是防止肺炎误诊肺结核的重要措施。     

Increased Risk of Surgery in Undiagnosed Celiac Disease

The diagnosis of celiac disease patients may be delayed by misdiagnosis. Our aim was to evaluate in celiac patients the prevalence of surgery before diagnosis. Two hundred forty-four adult celiac patients and 232 controls were retrospectively investigated for surgery before diagnosis of celiac disease. The prevalence of surgery was increased in celiac patients versus controls (P = 0.001). Frequency of appendectomy (P = 0.0001), tonsillectomy (P = 0.009), and hernia repair (P = 0.05) were increased in celiac patients versus controls. Appendectomy was related to anemia (P = 0.006) and abdominal pain (P = 0.005); tonsillectomy was related to diarrhea (P = 0.02) and weight loss (P = 0,04). Appendectomy was elective in 73% of celiac patients and in 46% of controls. Cosmetic surgery was increased in celiac patients versus controls (P = 0.058). In conclusions, surgery before celiac disease diagnosis is increased in celiac patients compared to controls, as a result of doctors' misdiagnosis and/or poor health status, which increases the demand for medical intervention. The frequency of cosmetic surgery in celiac patients may be related to impaired psychological profile of patients.     

The Relationship Between Psychogenic Cough and the Diagnosis and Misdiagnosis of Asthma: A Review

The differential diagnoses of persistent nonproductive cough include numerous pulmonary and nonpulmonary organic disorders as well as functional illnesses. Many diseases can cause cough, and several studies have shown asthma among the most common etiologies associated with chronic cough in adult nonsmokers, as well as children. Psychogenic cough and its relationship to asthma and other asthma-like illnesses is complex since distinct maladies with similar features may coexist individually or in combination in any given patient. While chronic cough may occur as a sole presenting manifestation of bronchial asthma in all age groups, recent findings suggest that most children with persistent cough without other respiratory symptoms do not have asthma. Since several organic, as well as functional diseases, may present with persistent cough as their sole manifestation in either adults or children, cough should not be used as a single or major determinant to diagnose and treat asthma, especially when empirically focused therapy trials fail. Given the range of illnesses causing cough, no single management guideline can be expected to be universally effective.     

31例脑囊虫病诊断探讨

本文报道31例脑囊虫病患者中23例(72.19％)被误诊为原发性癫痫、脑内肿瘤、病毒性脑膜脑炎、精神分裂症、蛛网膜下腔出血及视网膜炎6种疾病。误诊原因有对流行病学资料重视不够者11例(47.82％)、对癫痫为脑囊虫病主要表现认识不足者8例(34.78％)及临床表现不典型4例(17.39％)。重视流行病学资料,熟悉不典型表现,开展猪囊虫免疫试验,头部CT或MRI扫描及皮下结节活检有利于降低误诊率。     

急性胰腺炎误诊文献分析

目的 了解我国急件胰腺炎(acute pancreatitis,AP)的误诊现状,提高对AP的诊断意识.方法 通过中国期刊伞文数据库(CNKI网络版)检索1988年～2007年问发表与AP误诊有关的病例研究报告144篇,对被误诊的1098例AP患者的误诊疾病、临床表现、危险因素、辅助检查、确诊方法等进行回顾性研究.结果 (1)AP患者被误诊疾病多种多样,前5位依次是胆石症合并胆系感染(182例)、急性胃肠炎(158例)、急性阑尾炎(102例)、消化性溃疡(94例)、肠梗阻(90例);(2)患者最主要的临床表现是腹痛(878例),依据腹痛部位依次为中上腹痛(434例)、全腹痛(220例)、右下腹痛(79例)、右上腹痛(74例)、左上腹痛(71例)等;(3)胆囊结石是危险因素中占首位,为145例,其他依次为脂餐饮食(106例)、慢性胆囊炎(72例)和饮酒(67例)等;(4)依靠手术确诊的病例占首位,为378例,其他依次为淀粉酶(351例)、腹部CT(135例)、腹部B超(59例)等.结论 (1)对危险因素认识不足、临床表现缺乏全面正确分析,辅助检杏缺乏客观判断是误诊的主要原因;(2)动态血尿淀粉酶仍是诊断急性胰腺炎的主要方法,但有其局限性;对于不能确诊而高度怀疑者应及时行腹部CT或剖腹探查以明确诊断.     

25例输卵管结核误诊分析

目的探讨输卵管结核的临床特征和诊断、误诊情况,提高诊断的正确率。方法回顾分析25例输卵管结核患者的临床资料。结果25例患者多为年轻育龄妇女,多为农村人口或农民工,其临床表现复杂多样,误诊率高达76．0％。结论临床医师应认识到输卵管结核临床表现的复杂性,综合分析相关辅助检查,以减少误诊。     

高频彩色多普勒超声诊断浅表神经鞘瘤46例

目的：提高浅表神经鞘瘤的超声诊断价值,降低其超声误诊率。方法：回顾性总结经术后病理确诊的46例浅表神经鞘瘤高频彩色多普勒超声图像特征。结果：46例患者彩超诊断为神经鞘瘤40例,准确率为87．0％。结论：浅表神经鞘瘤在声像图上有一定的特征,要注意与淋巴结鉴别,避免误诊漏诊。超声检查浅表神经鞘瘤检出率及准确性较高,应成为临床首选的诊断方法。     

针吸细胞学皮肤奇异型平滑肌瘤误诊2例分析

This article reported that 2 cases with skin singular leiomyoma confirmed by pathology were misdiagnosed by fine needle aspiration biopsy, and the combination analysis of clinical history and pathological features of cells was as follows.     

多发性硬化症眼科误诊的临床分析

目的:分析以单眼视神经受损为首发症状的多发性硬化症的临床特点,探讨误诊原因。方法:对3例诊断为视神经炎及球后视神经炎,给予详细的眼科检查、VEP检查及颅脑MRI检查。结果:通过眼部检查、相关辅助检查及颅脑磁共振检查最后确诊3例单眼视神经受损的患者均为多发性硬化症。结论:多发性硬化症若以视神经受累为首发症状而无全身其他症状时,容易诊断为单纯性视神经炎而漏诊。