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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。

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。

首诊眼科的儿童嗜铬细胞瘤一例

Analysis of the central visual fields of pituitary adenoma

Objective To analyze the central visual fields and the ocular fundus changes of both eyes of patients with pituitary adenoma.Methods A total of 70 cases of pituitary adenoma received the examination of static central visual fields of all-liminal values by Humphrey instruments 750 cycloscope and the fundus exams by Topcon TRC-50X fundus photography before operations. Results There were 64.3% patients with decreased visual acuities, 80.7% with the defect of visual field, and 46 .4% with fundus changes. The decrease of the visual acuity was the first diagnostic symptom in 45.7% patients, among whom 28.6% were misdiagnosed as ocular diseases.Conclusions The misdiagnosed cause is that the first diagnostic symptom is the decrease of visual acuity without defect of visual field accompanied by ocular diseases. To avoid the misdiagnosis and the omitter of pituitary adenoma, general examination of visual field should be carried out in the patients with decreased visual acuity and optic atrophy with unknown reason in the clinical diagnosis of ophthalmology. (Chin J Ocul Fundus Dis，2003，19：18-19)

Analysis of 21 Cases of Acute Abdomen Misdiagnosed as Acute Appendicitis

目的 分析其他疾病误诊为急性阑尾炎的原因。方法 结合相关文献资料，对2004年2月至2008年12月期间本院21例其他疾病被误诊为急性阑尾炎的过程进行回顾性分析。结果 除了胆囊结石、胃穿孔、肠结核、异位妊娠等常见病可能被误诊为急性阑尾炎外，肝包虫、胆管癌、癔病、恶性淋巴瘤等也有可能被误诊为急性阑尾炎。误诊的主要原因是经治医生经验不足、思维局限、知识面狭窄，更重要的则是重视不足，检查不仔细、不全面。结论 系统和全面仔细地问诊、查体，努力提高辅助检查诊断水平等是减少误诊的关键。

急性主动脉夹层伴多器官灌注不良综合征一例

泪腺腺样囊性癌误诊为眼底病变一例

乳腺癌广泛腹腔转移误诊急性阑尾炎1例报道

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。

Misdiagnosis and Prognosis of Metastatic Ovarian Carcinoma from Gastrointestinal Tract

ObjectiveTo analyze the reasons for misdiagnosis of gastrointestinal metastatic ovarian cancer, in order to increase the rate of correct diagnosis and treatment, and to investigate the prognostic factors. MethodsWe retrospectively analyzed the clinical features, pathological features and prognostic factors of 43 cases of metastatic ovarian carcinoma from gastrointestinal tract treated between 2004 and 2014. ResultsGastrointestinal metastatic ovarian cancer was characterized by the diversity of clinical manifestations and lack of specific symptoms. The common initial symptom was pelvic mass, frequently accompanied with gastrointestinal symptoms of ascites, anemia or weight loss, abdominal pain, bloating, gastrointestinal obstruction and bleeding. Signs and symptoms of primary and secondary tumor sites often coexisted with each other, leading to misdiagnosis. Univariate analysis showed that primary site, histological type, surgical treatment, the residual tumor debulking size, lymph node metastasis, tumor invasion and standard chemotherapy had significant impacts on the prognosis (P < 0.05). ConclusionsGastrointestinal metastatic ovarian cancer occurs in premenopausal women, often with ascites, abdominal pelvic masses as the first symptom. Primary tumor site is often ignored, and the initial correct diagnosis rate is low. Metastasis from stomach cancer is the most common, followed by colorectal cancer and esophageal cancer. Prognosis is correlated with the primary site, histological type, degree of differentiation, depth of invasion, lymph node metastasis and other factors. Radical surgery and chemotherapy can improve survival.