Correspondence analysis as a screening method for indicants for clinical diagnosis

In clinical diagnosis, a patient's symptoms are observed and the probabilities of various diseases are assessed. A widely used method of formalizing this approach is independent Bayes in which symptoms are assumed to be independent conditional on the disease category. Correspondence analysis provides a method for examining the dependence between symptoms and assists in the selection of a reduced set of symptoms for the application of the independent Bayes method. This approach is illustrated on two data sets concerned with patients attending Accident and Emergency departments with chest pain and acute abdominal pain, respectively.     

Role of blast cell immunophenotyping for the diagnosis and prognosis of acute myeloid leukemia.

Bone marrow blast cell antigen expression from 86 patients with de novo acute myeloid leukemias (AML) was studied and correlated with FAB classification and clinical outcome. Among a panel of 14 monoclonal antibodies routinely used for the diagnosis of acute leukemias we studied the expression of six antibodies (CD13, CD15, VIM2, CD33, CD14, CD34) of the granulomonocytic lineage and found that some of them were useful for diagnosis and/or prognosis. For FAB subclassification of AML, the CD13 or VIM2 antigen expression was of no benefit. Monocytic leukemias (M4 + M5PD + M5WD) more frequently expressed CD34 antigen (28/31) than granulocytic (M1 + M2 + M3) subtypes (33/53) (P < 0.01). Finally, the most striking differences were found with CD14 antigen expression: CD14 antigen was more frequently expressed in M4 + M5 leukemias (21/31) than in M1 + M2 + M3 subtypes (12/33) (P < 0.01). The mean percentage of CD14 positive blast cells was accordingly higher in monocytic leukemias than in granulocytic leukemias and the difference was highly significant (P < 0.0001). The CD15 antigen was more frequently expressed in differentiated leukemias (M2 + M3 + M4 + M5WD) (35/44) than in poorly differentiated forms (M1 + M5PD) (17/37) (P < 0.001). The statistical difference was higher when the mean percentage of CD15 positive blast cells were compared (P < 0.0003). Moreover these latter percentages were different in M1 and M2 subtypes (P < 0.003). The blast cell expression of CD13, CD14, CD15 or CD33 was not predictive of the length of CR or survival. Moreover, our results support previously published findings suggesting a longer overall survival duration for patients whose leukemic cells do not express the CD34 antigen (P < 0.01). We also confirm that patients with the more differentiated subtypes of AML (CD13-, CD34+) tend to survive longer than patients with the less differentiated subtypes of AML (CD13-, CD34+) (P < 0.001).     

HCVRNA阳性的丙型肝炎诊断和治疗探讨

HCVRNA阳性的丙型肝炎46例，均经临床和／或组织学确诊。治疗组24例用IFNa－nl或a－2b3×106IU，隔日一次；对照组22例用一般护肝药物。HCVRNA12周转阴率治疗组为83．3％，对照组为9．0％（P＜0．001）。ALT和AST复常率治疗组也优于对照组（P＜0．05）。随访观察满48周者治疗组15例中HCVRNA持续转阴11例（73．3％）．对照组5例均持续阳性。治疗组中5例做了Ⅰ～Ⅲ型HCV基因分型，结果均为Ⅱ型。同时对急、慢性丙型肝炎的发病过程和病理诊断作了讨论。     

Family system test (FAST): Are parents' and children's family constructs either different or similar,or both?

Perceptions of family cohesion and hierarchy structures were assessed by theFamily System Test (FAST), a clinically-derived figure placement technique. Parents (N=140) and their preadolescent offspring (N=70) completed typical and conflict representations in individual as well as group settings. Typical representations were characterized by balanced family structures (i.e. cohesive and moderately hierarchical) and those displaying conflict situations showed predominantly unbalanced patterns. FAST portrayals were related to respondent (mother vs. father vs. child). Fathers represented typical family relations as balanced more often than mothers. Regarding conflict representations, children were more likely than fathers to portray the family as unbalanced. However, analyses of representations of the same family (i.e. intra-family comparisons) indicated that all respondents differed in their perceptions and, that fathers' typical portrayals showed most often the same structure as those done by the family members as a group.     

超声诊断异位妊娠249例临床分析

目的为了提高对异位妊娠的诊断技术。方法选择在我院经手术病理证实的异位妊娠249例住院患者行2DB超和CDFI的声像图特征进行分析。结果2D超声声像图特征在249例异位妊娠中内膜增厚223例，厚度为4—8mm／2；宫内假环状孕囊28例，大小为4．12mm；宫外探及孕囊178例，大小为8-48mm；盆腔混合性包块28例，大小为40．80mm：伴有黄体囊肿的123例，存活宫外孕3例，可显示原始心管搏动；CDFI声像图特征为宫外孕急性破裂的患者显示肿块及周围组织的彩色血流信号增多，动脉频谱血流速度增快，RI降低。结论超声检查对妇产科急诊有显著性作用，可直接指导临床明确诊断，选定治疗方案。     

骨髓腔静脉造影在特发性股骨头坏死诊断中的应用

本文介绍17例（34髋）特发性股骨头坏死、4例（4髋）正常人骨髓腔静脉造影所见。发现25髋有异常改变,并经病理证实。作者认为:①骨干返流;②2支或2支以上静脉不显影;③多条静脉明显变细;④干骺端瘀积是股骨头坏死的造影表现,前二者是可靠的诊断依据。造影结果提示髓腔静脉造影是一种安全而敏感的诊断技术。     

Early diagnosis of SARS: lessons from the Toronto SARS outbreak

The clinical presentation of SARS is nonspecific and diagnostic tests do not provide accurate results early in the disease course. Initial diagnosis remains reliant on clinical assessment. To identify features of the clinical assessment that are useful in SARS diagnosis, the exposure status and the prevalence and timing of symptoms, signs, laboratory and radiographic findings were determined for all adult patients admitted with suspected SARS during the Toronto SARS outbreak. Findings were compared between patients with laboratory-confirmed SARS and those in whom SARS was excluded by laboratory or public health investigation. Of 364 cases, 273 (75%) had confirmed SARS, 30 (8%) were excluded, and 61 (17%) remained indeterminate. Among confirmed cases, exposure occurred in the healthcare environment (80%) or in the households of affected patients (17%); community or travel-related cases were rare (<3%). Fever occurred in 97% of patients by the time of admission. Respiratory findings including cough, dyspnea and pulmonary infiltrates evolved later and were present in only 59, 37 and 68% of patients, respectively, at admission. Direct exposure, fever on the first day of illness, and elevated temperature, pulmonary infiltrates, lymphopenia and thrombocytopenia at admission were associated with confirmed cases. Rhinorrhea, sore throat, and an elevated neutrophil count at admission were associated with excluded cases. In the absence of fever or significant exposure, SARS is unlikely. Other clinical, laboratory and radiographic findings further raise or lower the likelihood of SARS and provide a rational basis for estimating the likelihood of SARS and directing initial management.     

颞颌关节继发性滑膜炎的临床诊断

颞颌关节滑膜炎分为原发性和继发性两种，颞颌关节紊乱综合症的滑膜炎为继发性滑膜炎。本文通过对１０６例颞颌关节紊乱综合症患者的临床检查、关节许氏位以及关节上腔造影的Ｘ线检查，同时对４２例进行了关节内窥镜检查，在此基础上探讨了继发性滑膜炎的临床诊断标准．作者认为急性滑膜炎主要是以关节疼痛和滑膜血管的改变为主，慢性滑膜炎的临床症状与滑膜组织改变以及关节骨组织的改变均有关系。     

Lhermitte-Duclos disease

Lhermitte-Duclos disease (dysplastic gangliocytoma of the cerebellum) is a rare pseudo-neoplastic disorder of the cerebellum with typical MRI findings. A 25-year-old man presenting with progressive neck pain, dizziness, and impaired vision is reported. CT and MRI revealed a left cerebellar haemispheric mass and obstructive hydrocephalus. Lhermitte-Duclos disease was histologically confirmed after surgical removal of the lesion. The typical MRI appearance of a nonenhancing haemispheric cerebellar mass with preservation and exaggeration of the normal gyral pattern allows pre-operative diagnosis of this condition. The literature is reviewed and clinical presentation, radiology and histopathology are discussed.     

BTA在膀胱癌诊断中的应用

为了探求对膀胱肿瘤诊断及术后复发监测的理想手段，从１９９５年９月～１９９６年６月，采用ＢＴＡ试剂检测方法对２０２例血尿患者及７１例膀胱肿瘤术后的患者进行了诊断检测，诊断膀胱癌的敏感度为９６％、特异度为８３％、准确度为８６％，２６例膀胱肿瘤患者中仅６例（２３％）尿脱落细胞阳性，正常对照均为阴性。认为ＢＴＡ试剂是一种快速、有效、无创性诊断膀胱肿瘤的方法。