CT及MRI在直肠癌诊断和分期的应用价值研究

目的:探究在直肠癌的诊断以及分期方面,CT与MRI技术的应用价值。方法:选取我院近年来经过病理检测,确诊为直肠癌的患者160例,随机分为两个实验组,其中一组采取CT成像方法,另一组患者采取MRI成像。并记录在不同的分期中CT及MRI的应用价值。CT诊断包含了常规CT平扫以及CT增强扫描,MRI诊断包括轴位DWI、T2W1冠状位以及矢状位、轴位T1WI、轴位T2WI的图像。结果:在直肠癌的诊断中,CT诊断的T分期与病理性T分期差异不大,其准确率为70.0%。MRI诊断的T分期和病理性T分期差异极小,其准确率为85.0%。CT诊断的N分期与病理性N分期差异不大,准确率为72.5%;MRI诊断的N分期与病理性N分期差异较小,其准确率为87.5%。CT诊断的T分期以及N分期的准确率与MRI诊断的T分期以及N分期的准确率之间差异均存在统计学意义(P0.05)。结论:在直肠癌的术前诊断以及局部分期中,MRI诊断与CT诊断相比,有更高的诊断价值。     

临床诊断书写规范化方法研究

目的 规范临床诊断书写,为DRGs付费制度的实施做准备。方法 建立临床诊断字典,临床医师通过电子病历系统从临床诊断字典中选择诊断名称。结果 95%以上的临床诊断名称均来自临床诊断名称字典,保证了临床诊断名称的规范性,同时能够直接与ICD10编码对应。结论 建立临床诊断字典能够规范临床诊断的书写,同时为提高临床诊断编码的准确性奠定了基础。     

血液光谱在疾病诊断中的应用

本文介绍光谱技术在血液诊断学研究中的应用原理与研究现状;包括利用光谱技术进行癌症的诊断,白血病的诊断,血液中微量元素与疾病检测的关系等。讨论利用光谱技术进行诊断存在的问题并展望其在疾病诊断上的应用前景。     

头颅CT、头颅MRI 在结核性脑膜炎诊断中应用

结核性脑膜炎是中枢神经系统感染性疾病中常见病,且致死率、致残率都很高.结核性脑膜炎的临床表现具有非特异性性,因此临床上容易引起误诊、漏诊.目前结核性脑膜炎的诊断主要是依据临床资料,脑脊液检查、生化及病原学和影像学检查等综合诊断方法.早期诊断及治疗和结核性脑膜炎的预后有着密切的关系,提高早期诊断是改善结核性脑膜炎顸后关键.头颅CT、头颅MR在结核性脑膜炎诊断中有着重要的作用,对结核性脑膜炎的诊断可提供重要的价值.本文就头颅CT及头颅MR在结核性脑膜炎中的作用做一综述.     

Flow cytometric diagnosis of myelodysplasia and myeloproliferative disorders

The current diagnosis of both myelodysplastic syndromes and myeloproliferative disorders relies in large part on subtle and subjective morphologic findings and the presence of cytogenetic abnormalities. Consequently, diagnosis of these disorders is often difficult and tentative with diagnosis at early stages representing a particular challenge. There is a need for new diagnostic techniques to allow a more definitive and objective diagnosis for these diseases. The published literature relating to the potential diagnostic utility of flow cytometric immunophenotyping in the diagnosis of myelodysplastic syndromes and myeloproliferative disorders is reviewed, and the increasingly important contribution of this technique to the diagnosis of these disorders emphasized.     

结核分枝杆菌蛋白抗原的研究进展

结核病当今世界人类致死的主要疾病之一,早期诊断发现病人、选择敏感的抗结核药物进行有效治疗是控制结核病的关键。而临床上对结核病患者检出率低,漏诊率和误诊率高,结果导致结核耐药的情况越来越严重。简便、快速、准确的免疫学检测方法在诊断结核病中起到了重要的作用。本文对用于免疫学检测的蛋白抗原作一综述。     

Domestic microwave processing for rapid immunohistochemical diagnosis of bovine rabies

The present study describes the use of a microwave processing protocol for the rapid histopathological and immunohistochemical diagnosis of bovine rabies. Immunohistochemistry has been used for rabies diagnosis in formalin-fixed tissue with satisfactory results, although the time to diagnosis is considerably longer than that with direct immunofluorescence. The protocol provided a provisory histopathological rabies diagnosis in approximately three and half hours and the immunohistochemical diagnosis was available after six hours. The protocol achieved 100% correlation with direct immunofluorescence and is a promising method, particularly in situations in which only material in formalin is available for diagnosis or when the refrigeration or transportation of biological material is difficult.     

The clinical history and costs associated with delayed diagnosis of bipolar disorder

The purpose of this reported study was to determine healthcare utilization and costs associated with delayed diagnosis of bipolar disorder. With use of automated data from a large integrated health system in the Midwest, all patients with newly diagnosed bipolar disorder recorded in any inpatient or outpatient encounter from January 1, 2000 to August 31, 2002 were identified. The date of initial diagnosis was the index date. For each patient in the bipolar cohort, 5 comparison patients were randomly selected from the general population of health system members and matched with the bipolar patients by sex, race, and age (-/+ 5 years). Data on healthcare utilization (inpatient, outpatient, emergency department, pharmacy) were collected with a focus on mental health, from January 1, 1990, through 1 year after the index date. The cohort is 62% female and 64% White. Median time between initial mental health diagnosis and bipolar diagnosis was 21 months, with 33% of subjects receiving a bipolar diagnosis within 6 months of their initial mental health diagnosis; however, for 31% of the remaining bipolar subjects, the time of their initial mental health presentation to bipolar diagnosis was 4 years or more. The number and duration of treatment with antidepressants increased as time to bipolar diagnosis increased. Patients with bipolar disorder had at least twice the number of interactions with the healthcare system before the index date than the non-bipolar comparison group. Mean monthly costs before and after bipolar diagnosis were not strikingly different for patients with bipolar disorder, but costs after bipolar diagnosis increased with increasing time to bipolar diagnosis. Bipolar disorder is a costly illness for which the impact on the healthcare system may vary depending on how quickly it is diagnosed. Delays in diagnosis appear related to additional costs after diagnosis.     

Value of antenatal diagnosis of abnormalities of the urinary tract.

OBJECTIVE--To assess the value of antenatal diagnosis of abnormalities of the urinary tract on ultrasonography. DESIGN--Retrospective study. SETTING--Two obstetric units in Glasgow. SUBJECTS--62 Fetuses in which renal abnormalities were diagnosed on antenatal ultrasonography. INTERVENTIONS--Six fetuses had their bladders aspirated to determine renal function. Fifteen pregnancies were terminated on the basis of the findings on antenatal ultrasonography, and if possible necropsy was performed on the fetuses. In babies who were born alive the final diagnosis was made by postnatal ultrasonography, intravenous urography, radionuclide scanning, cystography, and, in those who died in the early neonatal period, necropsy. Neonates who were referred with a known obstructed kidney had nephrostomy or pyeloplasty. END POINT--Assessment of the value of antenatal diagnosis of renal abnormalities on ultrasonography for babies who had no clinical evidence of disease postnatally. MAIN RESULTS--Eighteen fetuses did not survive birth; the antenatal diagnosis was accurate in all 18. Of the 44 babies born alive, five had normal urinary tracts, in two of whom antenatal ultrasonography had probably indicated a false positive diagnosis. Fourteen babies died during the early neonatal period. Twenty five babies with renal abnormalities were followed up; the antenatal diagnosis was inaccurate for 10 of them, the commonest misdiagnosis being hydronephrosis for multicystic kidney and vice versa, and there was one false positive diagnosis. The initial clinical findings in 14 babies would have led to the early detection of a urological abnormality. In the 30 babies with no clinical evidence of disease the antenatal diagnosis was of definite value in eight, probable value in 15, and marginal value in seven. Overall, an accurate antenatal diagnosis was made in 46 of the 62 cases (74%); in 12 cases renal disease was detected but its specific nature was not determined; and in four cases the diagnosis was misleading. CONCLUSIONS--The overall value of antenatal diagnosis is that it indicates early termination of fetuses with fatal renal disease, prepares parents and medical staff for the likelihood of serious neonatal problems, and shows abnormalities of the urinary tract that may not be detected postnatally.     

Comparison of echocardiography and 64-slice spiral computed tomography in the diagnosis of congenital heart disease in children

The diagnosis of congenital heart disease in children has been an issue in the medical community. Timely diagnosis and treatment can provide a greater guarantee for children's healthy growth. In recent years, there have been more and more studies on the diagnosis of congenital heart disease in children. This paper compares the advantages and disadvantages of echocardiography and 64-slice spiral computed tomography (CT) in the diagnosis of congenital heart disease in children. In clinical trials, we also tested 64 patients with spiral computed tomography (SCT) and transthoracic echocardiography (TTE) detection of patients and then confirmed the accuracy of the diagnosis by the surgical methods. The two methods of detection, the rate of missed diagnosis, and the rate of misdiagnosis were counted. Through the test results and pathological diagnosis results, the diagnostic accuracy of the two methods were all above 90%, each with its own advantages and disadvantages. The sensitivity of echocardiographic in detecting intracardiac structure abnormalities was relatively high, but when the diagnosis of extracardiac structural abnormalities less than 64-slice spiral CT method, misdiagnosis of TTE was mainly due to extracardiac vascular malformations. Therefore, it is recommended to combine the two methods to improve the diagnosis of congenital heart disease in children.     

以中枢神经系统症状为首发表现的干燥综合征1例并文献复习

目的:探讨干燥综合征累及中枢神经病变的临床表现及诊断、鉴别诊断、治疗。方法:报告中国人民解放军第175医院1例累及中枢神经病变的干燥综合征患者的临床资料并复习相关文献,对其临床表现、诊断、容易混淆的鉴别诊断及治疗进行分析。结果:1例累及中枢神经病变的干燥综合征患者经治疗病情好转出院。结论:累及中枢神经病变的干燥综合征,尤其以中枢神经系统症状为首发表现者,极易误诊为多发性硬化,遇可疑病例应及时完善检查,避免因忽视其它系统症状而导致漏诊和误诊,影响患者的预后。     

Prenatal sonographic diagnosis of skeletal dysplasias. A report of 47 cases

The purpose of this study was to evaluate the foetal sonographic efficiency for prenatal diagnosis of osteochondrodysplasias. Forty-seven prenatal and postnatal cases diagnosed between January 1993 and December 1998 in the referral sonographic centres of Strasbourg were studied. All cases were reviewed retrospectively and the prenatal ultrasound findings and diagnosis were compared to the postnatal or post-mortem diagnosis. Each case was studied by ultrasonographers, geneticists, radiologists, and foetopathologists. Final diagnosis was based on clinical examination, skeletal survey and molecular testing as deemed necessary. Routine screening and dating was the indication for foetal sonography in 72% (32/47) of our cases. The most likely time of diagnosis was between 16 and 24 weeks of gestation (17 out of 47 cases, 36%), which corresponds to the time of foetal anomaly sonographic scan in France. The other cluster of cases (12 among 47, 26%) was disclosed before 16 weeks of gestation. These results illustrate the importance of a detailed evaluation of the limbs during sonographic examinations of first and second trimesters of pregnancy. While the identification of skeletal dysplasias was relatively easy in our study, the ability to make an accurate specific antenatal diagnosis was more difficult. An accurate diagnosis was proposed in 28 of the 47 cases (60%). In 19% of the cases (9/47), the prenatal diagnosis was not accurate; in 21% of the cases (10/47), the prenatal diagnosis was imprecise. In 45 of the 47 cases (96%) prenatal foetal scan correctly predicted the prognosis.     

TCT、阴道镜下活检和LEEP对CIN诊断价值的比较

目的：评价TCT检查、阴道镜活检和LEEP活检在宫颈上皮内瘤变（ClN）诊断中的价值,比较其差异。方法：对324例经TCT加阴道镜下活检诊断为CIN的患者进一步行LEEP,采用对比研究TCT、阴道镜下活检和IEEP活检病理结果。结果：TCT检查与阴道镜活检诊断结果的完全符合率为65．1％,TCT结果与LEEP活检病理学诊断结果的完全符合率为69．4％,诊断过度11．4％,诊断不足18．5％。阴道镜下宫颈活检结果与LEEP活检病理学诊断结果的完全符合率为68．2％,诊断过度21．9％,诊断不足9-3％,后两种方法的诊断结果差异有统计学意义（P〈O．01）。结论：TCT是辅助诊断CIN的有效方法;单独阴道镜下活检诊断CIN的准确性尚不够理想,阴道镜下活检不能替代LEEP活检;TCT诊断CIN者在初次治疗时可用LEEP一次完成诊断和治疗。     

粪便RNA的检测在大肠癌早期诊断中的应用

大肠癌是胃肠道恶性肿瘤之一,在我国大肠癌的发病率和死亡率呈上升趋势。由于死亡率与大肠癌的诊断时间密切相关,因此早期诊断大肠癌尤为重要。但是目前临床常规诊断方法存在一定的局限性,难以实现大肠癌的早期诊断。粪便RNA检测技术是近年来发展的基于分子水平的早期无创检测大肠癌的技术,与常规检测技术包括结肠镜检测、大便隐血检测和粪便DNA突变检测相比,粪便RNA检测具有成本低和灵敏度高等优点,并可同时分析多种基因表达量和动态监测肿瘤进展。文章介绍了粪便RNA检测的可行性,系统阐述了用于粪便RNA检测的特异性基因、粪便RNA的提取方法和粪便RNA的检测技术,并对粪便RNA检测技术在大肠癌早期诊断中的进一步应用进行了展望。     

超声诊断对输尿管结石的临床价值探讨

目的探讨超声诊断输尿管结石的临床价值,并对其声像图进行分析。方法分析我院2008年1月-2009年6月确诊的21例输尿管结石患者的超声声像图及诊断符合率情况。结果21例输尿管结石中超声确诊19例,诊断符合率90．48％。结论超声诊断输尿管结石具有方便、无创,诊断符合率高,值得临床推广和应用。     

Use of Kampo Diagnosis in Randomized Controlled Trials of Kampo Products in Japan: A Systematic Review

Background

The Committee for Evidence-based Medicine (EBM) of the Japan Society for Oriental Medicine started compiling Evidence Reports of Kampo Treatment (EKAT) in 2007. EKAT is a compilation of structured abstracts of randomized controlled trials (RCTs), along with comments by a third party reviewer. As of 31 December, 2012, there were 378 RCTs of Kampo medicines in Japan. The primary research question of this study is “How frequently is Kampo diagnosis used in RCTs of Kampo medicines?” The secondary research question is “When is Kampo diagnosis used in RCTs?”

Materials and Methods

The structured abstract (SA) of each RCT article was reviewed to examine how Kampo diagnosis was used in RCTs, especially how Kampo diagnosis was used in the randomization process.

Results

Kampo diagnosis was used before randomization in 27 RCTs (7.1%), after randomization in 31 RCTs (8.2%), and not used in 320 RCTs (84.7%). Before randomization, Kampo diagnosis was used as a criterion for inclusion in 10 RCTs, criterion for exclusion in 9 RCTs, and criteria for both inclusion and exclusion in 2 RCTs. Kampo formulas were determined according to Kampo diagnosis in 7 RCTs. After randomization, subgroup analyses according to Kampo diagnosis were done in 27 RCTs, and grade of disease severity at Kampo diagnosis was used for analysis as an endpoint in 4 RCTs.

Conclusions

Kampo diagnosis was used before randomization only in approximately 15% of RCTs, and the number of RCT articles using Kampo diagnosis after randomization was almost the same as that before randomization. Further studies to determine the good RCTs conforming to CONSORT requirements and good systematic reviews conforming to PRISMA requirements are needed to clarify the significance of Kampo diagnosis.     

Prenatal diagnosis of a case of familial recurrence of unilateral diaphragmatic agenesis

Prenatal diagnosis of different fetal malformations have been performed by echography. The authors report a case of recurrence of monolateral diaphragmatic agenesy in sibs. The diagnosis was achieved at the 23 degrees week of gestation. Some methodological details are also proposed to improve the possibility of early diagnosis. Embryological and epidemiological data have been evaluated.     

Diagnosis of Tuberculosis in a General Hospital

In a survey of 71 new cases of tuberculosis diagnosed in a general hospital the average interval between admission and diagnosis of tuberculosis (the diagnostic interval) ranged between 10 days for intrathoracic tuberculosis and 20 days for genitourinary tuberculosis. The average diagnostic interval was 10·9 days when tuberculosis was included in the initial differential diagnosis, and 22·8 days when other diagnoses were made. Undue delay in diagnosis occurred in 17 patients (24%). In eight this was due to failure to include tuberculosis in the initial differential diagnosis. Earlier diagnosis might have saved three of the five patients who died.In 21 patients (30%) a history of predisposing factors or associated illness was obtained. Ten of these had suffered from previous tuberculosis.The vital factor in diagnosis of tuberculosis in general hospital patients is consideration of this condition in the diagnosis of any unexplained illness, especially where a history of previous tuberculosis or a recognized predisposing factor is obtained.     

Reliability of telepathology for frozen section service.

One of the most promising applications of telepathology (pathology at a distance by electronic transmission of images in pathology) is frozen section diagnosis, especially because by means of this tool operations requiring an intraoperative histopathological diagnosis are feasible at hospitals without a pathologist on-site. For the introduction of this diagnostic tool into pathologist's daily practice the evidence of its diagnostic accuracy comparable to that of the conventional frozen section diagnosis is crucial. For this purpose the literature on the diagnostic accuracy of telepathological frozen section diagnosis was reviewed. In a metaanalysis these studies and reports, in which a total of more than 1290 cases had been examined, showed a slightly lower overall diagnostic accuracy (of the telepathological frozen section diagnosis) of about 0.91 than the conventional frozen section diagnosis with an average accuracy of about 0.98 found in an analysis of several studies (on frozen section diagnosis of different organs). This difference is at least predominantly caused by a higher rate of deferred and false negative frozen section diagnoses in the telepathological method, while the specificity of both methods, each more than 0.99 was not significantly different. In conclusion, the introduction of a telepathological frozen section diagnosis for hospitals without an acceptable access to a pathologist is justifiable already at the current state of the technological development especially when considering the advantages (time saving, reduction in costs) compared to the alternative of surgical interventions without access to an intraoperative diagnosis.