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1.
对已知患原发性肝癌者(简称肝癌)发生肝癌自发性破裂的诊断并不困难。但不少肝癌患者在并发肝破裂致血腹前,未知患有肝癌,急诊诊断颇为不易。嘉兴市第二医院1978年8月至1989年8月在收治的174例肝癌中,17例发生肝癌自发性破裂,均分别被误诊为脾破裂,肝血管瘤破裂,重型肝炎肝昏迷,不全性肠梗阻等病而贻误抢救时机。究其误诊原因,除通常的诊断思维方法简单化、首诊负责制不健全外,主要在于部份临床医师在肝癌破裂的诊断与鉴别诊断过程中,还存在以下一些概念上的僵化或模糊:(1)认为无出血性休克者不存在肝癌破裂;(2)误认无突发性腹痛者不会有肝癌破裂;(3)在进行急腹症的鉴别诊断时忽视肝癌破裂的可能;(4)未能认识到及时施行腹腔诊断性穿刺术及腹水进一步检测的重要性。 相似文献
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探讨恶心呕吐的病因,为临床诊断提供依据,避免漏误诊发生。方法:通过消化内科住院患者110例出现恶心和(或)呕吐症状,对其病因统计分析。结果:为恶心呕吐常见病为反流性食管炎、巨幼贫、胆系结石、颅内占位和功能性消化不良。结论:其它尚有十二指肠溃疡、粪石梗阻、肝功损害、肠系膜动脉缺血、急性阑尾炎、腹部术后和流行性出血热(EHF)等。乙型肝炎与十二指肠溃疡有关,急性支气管炎、白细胞减少症和溃疡性结肠炎可有恶心呕吐表现。 相似文献
4.
急性白血病的特殊临床表现及误诊分析 总被引：2，自引：0，他引：2
报告了以髓外浸润为特殊临床表现的小儿急性白血病１３例，首发症状为：骨关节、肌肉肿痛，骨折，脊柱畸形，眼球突出，黄疸，腮腺肿大．分析了引起误诊的主要原因及如何减少及避免误诊的体会，强调了早期诊断对改善小儿急性白血病预后的重要性 相似文献
5.
以《中国引文数据库》为统计源,采用共被引方法对我国图书馆学高频被引论文进行统计分析,透视我国图书馆学研究的主流领域。聚类分析的结果表明,我国图书馆学研究的热点主题包括:(1)数字图书馆;(2)网络信息资源研究;(3)用户服务;(4)知识管理;(5)图书馆2.0;(6)学科馆员;(7)复合图书馆;(8)信息素质教育。 相似文献
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青少年思想品德方面存在的主要问题:(1)缺乏社会责任感;(2)心理素质薄弱,自理能力差;(3)法制观念、是非观念淡薄。造成青少年政治思想素质滑坡的原因是多方面的,需要全社会来抓共管。 相似文献
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《科技风》2016,(2)
目的:探讨儿童皮肤黏膜接触性有机磷农药中毒的临床特点、误诊原因、防范措施,减少误诊复发率,为防治提供服务。方法:选择我院收治儿童皮肤黏膜有机磷农药中毒经皮肤黏膜等非消化道中毒的病例51例的临床资料作回顾性分析。结果:发现临床医生对急诊儿童有机磷农药中毒的特殊性了解不够,疏忽毒物接触史,体检不够仔细等。51例中被误诊28例,误诊率为54%,抢救成功49例,死亡2例,治愈率96%。结论:儿童经皮肤黏膜接触性有机磷农药中毒临床表现多样,不典型。部分儿童不能表达,病史不详,中毒后起病缓慢、隐匿。不易引起儿童家长及医务人员的注意,易被误诊。详细询问病史,及时测定胆碱酯酶活性,必要时用阿托品试验性治疗。利用早诊断、早治疗。可减少误诊,临床医生应提高对儿童急性有机磷农药中毒的认识,降低误诊率。 相似文献
8.
穿心莲常用于治疗各种感染性疾病、神经性皮炎、湿疹、血栓闭塞性脉管炎、麻风、急性黄疸型肝炎、钩端螺旋体病、肠伤寒等。穿心莲常用制剂有穿心莲片、穿心莲浸膏胶囊、穿心莲甙酯片、穿心莲丸、莲胆注射液、止痢宁片、消炎利胆片等。本文对穿心莲及其制剂的药理作用和临床进行研究。 相似文献
9.
《科学学与科学技术管理》2017,(3)
批判性反思被视为是决定员工创新行为的重要前因变量,但缺乏相关的实证研究,尚未出现关于这种关系的作用机理与传导机制的研究。基于对现有研究缺口的认识,以28家科技型企业的347名员工为调查对象,基于社会认知理论和自我调节理论,构建了包括中介环节的调节效应概念模型。研究结果显示:(1)批判性反思与员工创新行为显著正相关;(2)创新性过程投入在2者关系中起部分中介作用;(3)自我效能感在批判性反思与创新性过程投入之间起调节作用;(4)进一步,自我效能感调节了创新性过程投入对批判性反思—员工创新行为的中介作用。 相似文献
10.
目的：提高对肺癌的认识并分析肺癌误诊原因。方法：通过对100例病人详细问诊、复习有关资料，对其临床表现、影像学表现、纤维支气管镜检查及痰脱落细胞学等进行分析。结果：肺癌高发人群为40岁以上长期大量吸烟的男性44例(44％)、家族有肿瘤病史者23例(23％)、有长期慢咳病史者(15％)等。100例患者中82例(82％)有延误诊断的情况。患者自身造成的误诊55例(55％)，医源性误诊44例(44％)，医源性误诊原因有诸多环节。最易误诊的疾病为肺炎43％，高发人群其次为慢支、结核、哮喘各20％。结论：肺癌的临床表现复杂多样，对患者的临床表现和辅助检查进行综合分析，才能降低误诊率，提高肺癌患者的5年生存率。 相似文献
11.
对近年伤寒免疫学诊断方法结合作者的研究工作进行了评价。伤寒免疫学诊断可分检测早期病人体液中抗原及测定患者血清中抗体两个方面。检测抗原以SPA-CoA与ELISA(包括Dot-ELISA)较为敏感和特异,而DRLAT则有简便的优点。测定抗体以PHA最为简便与快速。使用LPS-PHA可作伤寒的早期快速诊断,而Vi-PHA可作伤寒病后带菌者的初筛。ELISA有较PHA更高的敏感性,其中LPS-IgM-ELISA亦可作伤寒病人的早期诊断,而LPS-IgG-ELISA可用于该病的追溯诊断和血清流行病学调查。Vi-ELISA还可作伤寒病后带菌者初筛。不同条件实验室可根据取得试剂情况选择使用。 相似文献
12.
介绍了头孢噻肟、头孢哌酮,拉他霉素、头孢三嗪及头孢他定等第三代头孢菌素在治疗伤寒方面的药理学优势和临床应用的进展.第三代头孢菌素治疗伤寒的主要要应症为:(1)多重耐药伤寒曹株引起的严重感染;(2)并发脑膜炎、骨髓炎、肺炎等;(3)伴有免疫缺陷或中性粒细胞减少的患者;(4)伴有肾功能不全的患者;(5)婴儿、儿童和孕产妇患者.对于多重耐药菌株所致的重症伤寒,第三代头孢菌素尚可与另一种有协同作用的抗生素联合用药. 相似文献
13.
本文对伤寒LPS-PHA诊断试剂盒进行现场应用评价.来自各医院和不同地区977份不同类型的血清标本作LPS-PHA检测的同时与Widal试验作比较,结果伤寒沙门氏菌血培养阳性46份血清标本前者检出率(86.96％)显著高于后者(67.39％),两者在统计学上有显著差异(X~2=4.999,P<0.025),95份Widal试验阳性血清LPS-PHA阳性率为97.89％,漏检2份系乙型副伤寒抗体阳性者.607份对照血清标本LPS-PHA的假阳性率1.48％,低于Widal试验(4.84％).伤寒LPS-PHA的敏感度和特异度(94.33％和98.52％)高于Widal试验(89. 36％和95.72％).其他5项评价指标(阳性和阴性预示值,粗一致性,调整一致性和约登指数)亦都较Widal试验好.因此,LPS-PHA诊断试剂盒能满足目前临床上早期快速诊断伤寒的要求.但不适用于追溯诊断和血清流行病学调查. 相似文献
14.
A. S. Bhatia Satish Kumar B. C. Harinath 《Indian journal of clinical biochemistry : IJCB》2003,18(2):1-5
Tuberculosis is still a major health problem in most developing countries and its incidence is rising in many developed countries.
This resurgence has been attributed to the HIV epidemic and TB has been declared as a global health emergency by WHO in 1993.
The diagnosis of tuberculosis mainly depends upon initial clinical suspicion and radiographic findings with subsequent bacteriological
confirmation by sputum smear examination and culture. Lack of sensitivity in smear examination, non specificity of radiological
findings, extended tum around time ofMycobacterium tuberculosis culture and difficulties in diagnosing paucibacillary, childhood and extrapulmonary tuberculosis has necessitated to explore
the utility of immunodiagnosis of tuberculosis as a convenient and cost effective test to supplement clinical information
for definite diagnosis. Many commercial tests are available in the market for diagnosis of TB. Most of these tests are based
on the detection of IgG, IgA and IgM antibodies to specific mycobacterial antigen or mixture of antigens. Indigenous immunoassay
systems have explored excretory-secretory ES-31 mycobacterial antigen for immunodiagnosis of TB. Many a time there is lack
of consistent elevation in all the three Ig classes in active infection thus making it more important to determine the ideal
antibody isotype assay for reliable diagnosis of tuberculosis and to save the costs of the patient for unnecessary investigations. 相似文献
15.
目的：通过对我市2007年生猪“高热病”疫情流行特征及流行相关因素进行分析,探讨动物疫病防制过程中存在的问题,并提出防治对策。方法：对2007年我市生猪“高热病”疫情资料以及当年实验室检测结果进行统计分析。结果：我市生猪“高热病”是外源性疫源传入,以高致病性猪蓝耳病病毒感染为主并混合感染多种病原引起;疫情区域相对集中、疫点呈点状散发、疫情传染速度快、各种日龄猪均可发病和死亡、发病率和病死率高为特征;疫病应急技术贮备不足、防控措施落实不到位、群众防疫意识低等原因导致疫情迅速扩散。结论：科学处置疫情、加强消毒灭源、强化免疫接种、加大防疫监管等综合措施是有效的防治对策。 相似文献
16.
对141例流行性出血热患者的心电图临床资料分析及1例流行性出血热患者猝死的原因和诱因探讨,提出流行性出血热患者心电图变化中的危险信号,以杜绝诱因,防止猝死的发生。 相似文献
17.
Anitha Devanath Jaya Kumari Jim Joe Saly Peter Sugirtha Rajan Laly Sabu Shivshankar Janet Mary Smitha Roselin Arokiasami 《Indian journal of clinical biochemistry : IJCB》2009,24(4):361-365
This retrospective study was conducted to assess the serum lipase / amylase ratio in acute pancreatitis for South Indian population attending the clinics of Gastroenterology and Emergency medicine in the last five years. One thousand one hundred and thirty two patients (768 males and 364 females) with acute pancreatitis (AP) were selected for the study. The diagnosis of AP was based on clinical evaluation, Computed Tomography (CT) findings and biochemical parameters such as serum lipase and amylase. Based on the etiology, the groups were divided into alcoholic, biliary and miscellaneous AP. Based on CT findings, groups were divided into mild, moderate and severe AP. Serum lipase, amylase and lipase / amylase ratio were calculated and statistically analyzed. Serum lipase levels in alcoholic group (3226.3 ± 1384.7) were significantly lower in comparison to biliary (6064.5 ± 1640.8) group though the levels were not significantly different from miscellaneous group (2132.3 ± 1210). Serum amylase values were significantly lower in alcoholic group (923.4 ± 557.5) in comparison to biliary (1736.2 ± 390.7) and there was significant difference between alcoholic and miscellaneous group (535.8 ± 477.6). The serum lipase / amylase ratio > 4 occurred in alcoholic group than with biliary and miscellaneous group. The sensitivity and specificity to predict alcoholic AP with lipase / amylase ratio at >4.0 was 84 % and 59 % respectively. In conclusion the serum lipase to amylase ratio greater than 3.0 could be used to differentiate but keeping the cut off at 4.0 would be of higher sensitivity without much change in specificity. The serum lipase to amylase ratio with a cut off of 3.0 or greater is not useful to differentiate the severe AP from milder AP. Hence, serum amylase and lipase are important for evaluation of pancreatitis though it is not a gold standard for the diagnosis or assessment of severity of acute pancreatitis. 相似文献
18.
HS Batra Ashwini Kumar TK Saha Pratibha Misra Vivek Ambade 《Indian journal of clinical biochemistry : IJCB》2015,30(2):230-233
To establish utility of single enzymatic marker for the diagnosis of acute pancreatitis. This is a cohort study. Tertiary care centre proven cases of acute pancreatitis (n = 50) admitted in surgery ward between December 2011 and May 2013 were included in the study. Serum amylase and lipase were performed along with many analytes. All relevant data including serum lab values and imaging were collected. All 50 patients included in the study had raised serum lipase, 42 patients had both amylase and lipase raised, 8 patients had amylase normal but lipase raised. In smaller hospitals where limited lab and radiological facilities are available, estimation of serum lipase will be a better choice over serum amylase in diagnosis of acute pancreatitis. 相似文献
19.
Simbita A. Marwah Hitesh Shah Kiran Chauhan Amit Trivedi N. Haridas 《Indian journal of clinical biochemistry : IJCB》2014,29(2):161-166
Currently employed markers for the detection of acute coronary syndrome are Troponin T, CK (Creatine Kinase) and CKMB activity. CKMB activity measured by immunoinhibition method can give falsely elevated results due to the presence of atypical CK and CKBB and at times lead to the mis-diagnosis of acute coronary syndrome. Hence, CKMB mass (CKMB) measured by electrochemiluminence sandwich principle was employed. In this cross-sectional study 183 samples of 61 patients were analyzed within 6 h of diagnosis of acute coronary syndrome and followed up to 72 h. The correlation coefficient between CKMB activity and CKMBM at 4–6 h was 0.744, while at 12–24 h it was 0.909 and at 48–72 h it was 0.337. Thus there was good association between the two methods at 12–24 h but, statistically for method comparison studies and for replacing one method by another, the two methods need to be in agreement with one another. In this study the two methods are not in agreement with one another and thus analytically not replaceable. Another finding was obtained that CKMBM reached cut off levels prior to CKMB enzyme activity and hence, CKMBM is clinically better than CKMB activity to detect reinfarction. 相似文献
20.
Banibrata Mukhopadhyay Shashikant Chinchole Valentine Lobo Sishir Gang Mohan Rajapurkar 《Indian journal of clinical biochemistry : IJCB》2004,19(2):14-19
Serum creatinine does not distinguish between various causes of graft dysfunction. Serial assay of proximal tubular enzymes
N-Acetyl-D-glucosaminidase (NAG), Alanine aminopeptidase (AAP) and Gamma glutamyl transferase (GGT) in urine was done to assess
their usefulness in distinguishing various causes of graft dysfunction. Daily serum creatinine and enzymuria were measured
in 32 consecutive renal allograft recipients for first 15 postoperative days. Graft dysfunction was defined as >20% increase
in serum creatinine and >100% increase in enzymuria over the baseline. The diagnosis of graft dysfunction was based upon clinical
criteria, ultrasonography, cyclosporin trough level, allograft biopsy, response to anti-rejection therapy and alteration of
cyclosporin dosage. Fifteen episodes of graft dysfunction were identified in 15 patients. The sensitivity and specificity
of the enzymes (NAG, AAP and GGT) for predicting graft dysfunction were 87.5%, 86.9%, 88.5% and 98.2%, 98.2%, 97.9% respectively.
There was a significant increase in enzymuria during acute tubular necrosis (ATN) and acute rejection episode compared to
cyclosporin nephrotoxicity (p<0.01). Enzymuria assay provides a simple, reliable and noninvasive method to distinguish cyclosporin
nephrotoxicity from acute tubular necrosis and acute rejection in renal allograft recipients. 相似文献