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Foster-Kennedy 综合征误诊为前部缺血性视神经病变一例

甲状腺功能亢进症32例临床分析

目的:提高对甲亢患者的诊治水平,减少误诊率。方法:依据甲亢患者临床表现,回顾性分析误诊病例与甲亢产生多系统表现的可能机制。结果:32 例中有22 例在首诊时误诊,误诊率68.7%,其中,男性,尤其是老年男性患者,主要以消瘦,营养不良性贫血,失眠,心房纤颤,腹泻,呕吐,低钾周瘫,白血球减少误诊;女性主要以心悸,经量减少或闭经,慢性腹泻,类风湿性关节炎误诊。结论:甲亢患者可出现多系统临床表现,误诊与病程长短、性别及年龄,高代谢不明显,突眼少见,甲状腺肿大不明显有关。因此,对一些不典型的甲亢患者,及时行甲状腺功能检查。

异位妊娠的误诊原因分析与防治对策

目的 探讨异位妊娠误诊的原因及防治措施。 方法 对我院自2006年1月-2009年11月收治的52例异位妊娠患者的临床资料进行回顾性分析，并探讨其误诊原因及减少误诊的对策。 结果 忽略必要的病史及体检是误诊的主要原因； 过分依赖辅助检查，尤以依靠B 型超声波检查为多见；提高对异位妊娠的警惕性是减少误诊的关键。 结论 加强对异位妊娠的认识，早发现，早治疗，避免因误诊导致死亡和严重并发症的发生。

Clinical features and missed and inaccurate diagnosis of Fuchs syndrome

Objective To investigate the clinical manifestations and possible reasons of the missed and inaccurate diagnosis of Fuchs syndrome. Methods The clinical data of 85 patients with Fuchs syndrome who were diagnosed and treated from June 1999 to December 2003 were retrospectively analyzed. The disease history of each patient was carefully recorded. Slit-lamp microscopy was performed on the patients. The character and distribution of keratic precipitates (KP), color of the iris, depigmentation, and complications were noted in detail. The data recorded in other hospitals were analyzed and the reasons of missed and inaccurate diagnosis were statistically analyzed. Results The age of the patients ranged from 13 to 72 years, and binocular involvement was noted in 76 patients. None of the patients showed ciliary congestion and iris synechiae. Middle-sized or stellated KP was found. Triangle-distributed KP was seen in 13 patients, and diffuse distribution behind the corneal or in the pupil area was in 72. Anterior-chamber flare was observed in all of the patients, while anterior-chamber cells were only noted in 42 patients. The iris with different degrees of depigmentation was found in all the patients. Complicated cataract and increased intraocular pressure occured in 44 and 19 patients, respectively. The diagnosis in other hospitals mainly included uveitis, anterior uveitis and complicated cataract. Conclusions Fuchs syndrome is characterized by depigmented iris and typical KP. Missed and inaccurate diagnosis is mainly due to the unawareness of its clinical features. (Chin J Ocul Fundus Dis, 2005, 21: 360-362)

脉络膜恶性淋巴瘤一例

Analysis of Delayed Diagnosis in 324 Cases of Nasopharyngeal Carcinoma

目的:探讨鼻咽癌延误诊断的原因。从而提高鼻咽癌患者的早期诊断率,改善治疗效果。方法: 回顾性分析324例在我科接诊前因各种因素而延误诊断的鼻咽癌患者首发症状、首诊误诊科室、误诊疾病。结果: 本组病例首发症状分别为颈部包块138例(42.5%)、鼻部症状148例(45.6%)、耳部症状66例(20.3%)、头痛46例(14.2%)、其他17例(5.2%),有两种首发症状的病例为91例。首诊误诊的疾病有颈部淋巴结炎、慢性鼻鼻窦炎、鼻出血、分泌性中耳炎、脑动脉硬化等27种疾病。涉及普外科、耳鼻咽喉科、神经内科、骨科、呼吸内科、口腔科、烧伤科、眼科、中医科等9个科室。结论: 加强鼻咽癌知识普及,完善继续医学教育及住院医师培训,积极寻找鼻咽癌的早期诊断方法能减少鼻咽癌的延误诊断。

Analysis of the Reason of the Misdiagnosis about Three Aortic Dissections

目的:探讨主动脉夹层患者误诊的原因,提高主动脉夹层患者的早期诊断率,为及时、正确救治患者生命提供有力的科学依据。方法:回顾性分析3例主动脉夹层患者实际诊断与误诊的情况,查明误诊原因。结果:3例主动脉夹层患者经检查后证实,1例误诊为急性食道撕裂伤或消化性溃疡,占33.33%;1例误诊为急腹症,占33.33%;1例误诊为急性颅内病变,占33.33%。结论积极评估其病情的危险程度,监测生命体征,快速建立静脉通道,同时仔细询问相关病史,认真查体,积极采取相应辅助检查,可降低误诊率。

误诊为脉络膜黑色素瘤的眼内炎性假瘤一例

急性主动脉夹层伴多器官灌注不良综合征一例

感染性心内膜炎的误诊研究：84 例临床报告

目的分析感染性心内膜炎的误诊原因。方法回顾性分析我科 2008 年 1 月至 2018 年 1 月确诊的 84 例感染性心内膜炎（infective endocarditis，IE）患者的临床资料，其中男 62 例（73.8%）、女 22 例（26.2%），中位年龄 39.5（11～77）岁。当患者出现符合 IE 的疑诊条件时，根据医师是否疑诊为 IE，将患者分为未误诊组（22 例）和误诊组（62 例）。比较两组患者的临床资料。结果全组患者体温>38℃ 占比 97.6%（82/84），心脏杂音 82.1%（69/84），脾肿大 27.4%（23/84），心力衰竭 27.4%（23/84），栓塞 46.4%（39/84）。首诊误诊率为 73.8%，上呼吸道感染、感染原因待查、下呼吸道感染是较常见的误诊病种。多因 IE 易患因素（P=0.001）、血管征象（P=0.001）、心脏杂音（P=0.034）、栓塞（P=0.004）等临床表现未引起医师重视而出现误诊，且被忽视的次要标准越多，越容易出现误诊（P=0.005）。结论对于不明原因反复发热、心脏杂音、合并血管栓塞等征象和各种 IE 易患因素的患者，应警惕 IE 的可能，及时采用 IE 诊断基石。临床医师应提高对 IE 的认识，注意加强多专业协作，从而减少 IE 的误诊。