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Cryptococcal Neoformane Meningitis: A Retrospective Clinical Study

Objective　To retrospectively analyze the clinical information of a series of patients with cryptococcal neoformans meningitis in order to improve the diagnosis and treatment level. Methods　Fifteen patients with etiological diagnosis as cryptococcal neoformans meningitis from January 2004 to December 2009 in the Affiliated Shengjing Hospital of China Medical University were included in the study. The clinical manifestations, treatment and prognosis of those patients were retrospectively analyzed. Results　Seven of the total 15 patients were misdiagnosed with misdiagnosis rate of 46.7%. Twelve patients were treated by combination of amphotericin B/Lipo-AMB and fluconazole intravenously infusion, and then followed by the maintenance therapy of fluconazole orally administration, of which 7 were cured, 3 were improved, and 2 died. Five patients undergoing lumbar cisterna drainage were all cured. The follow-up study showed that 4 cases were accompanied by auditory or/and visual dysfunction within 1 to 5 years after hospital discharge. Three cases died that were not treated with anti-fungal drugs. Conclusion　The misdiagnosis rate of cryptococcal neoformans meningitis is high. The keys to reduce mortality are raising vigilance, early diagnosis, rational use of antifungal drugs, and effectively lowering the intracranial pressure. The integrated therapy of amphotericin B/Lipo-AMB and fluconazole is effective and safe. Lumbar cisterna drainage can effectively lower the intracranial hypertension, quickly relieve symptoms and improve prognosis.

The Situation and Causes of Misdiagnosis of Hypoglycemia in China

Objective　To explore the situation and causes of misdiagnosed hypoglycemia in China so as to develop some strategies for reducing misdiagnosis.Methods　We searched CBMdisc, CMCC, CJFD and VIP (Jan. 1994-Dec. 2003). All the publisled studies about the misdiagnosis of hypoglycemia were collected to analyse their classifications and causes.Results　A total of 172 studies involving 1 478 patients met the inclusion criteria. The studies were either case reports or clinical reviews. The 1 478 cases were misdiagnosed as 31 sorts of diseases, mainly including stroke (71.18%), transient ischemia attack (4.87%), epilepsy (4.13%) and hepatic coma (2.64%) . The causes of misdiagnosis could be classified into 14 categories, including complex manifestations of hypoglycemia (29.07%), lack of knowledge of hypoglycemic encephalopathy (16.44%), insufficient medical history collection (10.21%) and interference of compound diseases (9.86%) etc..Conclusions　The misdiagnosis of hypoglycemia is mainly caused by the poor professional skills of doctors or their lack of responsibility, and poor patient management, especially when hypoglycemia are manifested by brain disability.

Reasons of Missed Diagnosis and Misdiagnosis of Glandularis Cystitis by Ultrasonography

【摘要】　目的　分析超声对腺性膀胱炎的误、漏诊原因，探讨减少其误、漏诊的方法。　方法　回顾性分析2006年1月-2010年2月经病理证实的135例腺性膀胱炎的声像图表现。　结果　135例腺性膀胱炎患者中，超声误诊26例，误诊率19.3%，漏诊11例，漏诊率8.2%。误诊的主要原因：乳头结节型和团块型与膀胱肿瘤声像图极为相似、容易混淆，超声医师对膀胱壁各层次的观察不仔细，对病史重视不够；漏诊的主要原因：膀胱充盈不佳或不充盈，病变体积太小、位于前壁或顶部，或病变位于膀胱后壁及颈部被明显增生的前列腺、膀胱内血凝块及膀胱结石等掩盖。　结论　超声是诊断腺性膀胱炎常用方法，但存在一定的误、漏诊，改进检查方法，可减少其误、漏诊发生。【Abstract】　Objective　To analyze the reasons of missed diagnosis and misdiagnosis of glandularis cystitis by ultrasonography.　Methods　The sonographic outcomes of 135 patients with glandular cystitis diagnosed by pathological examination from January 2006 to February 2010 were retrospectively analyzed.　Results　In 135 patients, misdiagnosis was in 26 with a rate of 19.3%, missed diagnosis was in 11 with a rate of 8.2%. The reasons of misdiagnosis included: the sonographic outcomes of mastoid and tuberculous conglomeration were similar to those of bladder tumour; the ultrasonographic professionals didn’t clearly observe each layer of the bladder wall, and didn’t pay enough attention to the disease history. The reasons of missed diagnosis included: the bladder was under-filled or unfilled, the size of the lesions were too small and were located at the anterior wall or the top, and the lesions were located at the posterior wall and neck of the bladder which were covered up by obvious prostate hyperplasia,and gores or stones of bladder so that the lesions could not be observed.　Conclusion　Ultrasonography is a usual method for diagnosing glandular cystitis,and we should ameliorate the examination to decrease the misdiagnosis and missed diagnosis.

Clinical Analysis of 10 Cases with Paralytic Dementia Misdiagnosed as Functional Mental Disorders

目的:探讨被误诊为功能性精神障碍的麻痹性痴呆患者的临床特点和诊治要点。方法:回顾性分析10例被误诊为功能性精神障碍的麻痹性痴呆患者的临床资料。结果:被误诊为功能性精神障碍的麻痹性痴呆均以精神症状为首发，多表现为精神病性症状、类躁狂、抑郁、类神经症、人格的改变及进行性痴呆等不典型症状群，本研究显示误诊率高达71.4%，误诊例次率以精神分裂症最高（47.3%），其次为躁狂症或躁狂状态（37.5%）。抗精神病药物能有效改善精神症状，青霉素驱梅能阻止病情进展使病情得到缓解，两者缺一不可。结论:被误诊为功能性精神障碍的麻痹性痴呆均以精神症状为首发且症状不典型而易被误诊，早期鉴别诊断十分重要，抗精神病药物和青霉素治疗可以有效控制症状。

Clinical Features and Formation of Acute Abdomen Caused by Non-Abdomen Diseases

The Preventive Measures of Misdiagnosis and Missing Diagnosis of Blunt Abdominal Trauma

Objective To investigate the reasons of misdiagnosis and missing diagnosis in blunt abdominal trauma (BAT), and to put forward effective preventive measures. Methods Literature on BAT diagnosis in recent years was reviewed. Results Misdiagnosis and missing diagnosis, which can take place in every segment of BAT patients, were still quite common nowadays. Conclusion Detailed case history collecting, faithful medical examination and making good use of assistant examinations can efficiently decrease the misdiagnosis and missing diagnosis rates of BAT patients.

肺隔离症误诊为脓胸一例

临床资料 患者女性, 21 岁。因“反复咳嗽1 年余”入院。患者1 年前无明显诱因出现咳嗽, 无痰, 无发热、盗汗、乏力。当地医院给予抗感染治疗症状缓解。以后患者反复出现干咳, 口服抗生素及止咳药好转。2 周前又出现干咳,到当地市立医院就诊。胸片示右侧胸腔积液; 胸腔彩超示右侧胸腔包裹性积液, 内部可见粗点状回声及分隔光带回。血白细胞11. 02 ×109 /L, 中性粒细胞0. 499, 淋巴细胞0. 408;胸腔穿刺共抽出30 mL 脓液, 查胸水白细胞11 400 ×106 /L,中性粒细胞0. 41, 淋巴细胞0. 59。给予头孢哌酮/ 舒巴坦3 g静脉滴注, 2 次/d, 治疗1 周, 患者仍干咳, 并出现右侧胸部不适。‥‥‥

Misdiagnosis Analysis of a Case with Motor Neuron Disease Whose Main Presentation Is Pulmonary Hypertension

Objective To summarize the clinical features of motor neuron disease ( MND) with main presentation of pulmonary hypertension, so as to improve the diagnosis.Methods A patientwithMND whose main presentation was pulmonary hypertension was analyzed retrospectively. Meanwhile related literatures were reviewed. Clinical data including symptoms, early signs, misdiagnosis causes, and necessary functional examination of respiratory muscle were collected. Results The symptoms of MND was slow-onset and insidious with gradual progression over time. History inquiring found that the symptoms of muscle wasting and physical debilitation emerged long time before the respiratory symptoms. Physical examination also revealed obvious sign of muscle atrophy. Conclusions MND with main presentation of pulmonary hypertension has been recognized insufficiently and often misdiagnosed as other pulmonary diseases. Detailed history taking, systematic physical examination, and convenient functional examination of respiratory muscle,can not only reduce misdiagnosis, but also avoid some expensive and traumatic process.

极不典型的肺结核一例误诊分析

肺结核目前仍是全球最严重的传染性疾病, 据世界卫生组织统计每年有超过800 万的新发肺结核病例, 大约有300万患者死于肺结核, 95% 以上的肺结核发生在发展中国家[ 1] 。近年来由于农村人口城镇化的速度剧增、艾滋病发病率上升、结核杆菌耐药菌株产生及医护人员对不典型性肺结核的认识不够等多种因素, 导致不典型性肺结核病发病率逐年增高。由于不典型肺结核临床表现无特异性、胸部影像学多变性、血清学检查缺乏特异性及病菌检出率低等因素, 易被临床工作者漏诊或者误诊。现报告1 例极不典型肺结核的误诊经过。

肺部周围球形病灶误诊原因分析

目的对行影像学检查后误诊的肺部球形病灶进行分析，以期提高对该类疾病的诊断正确率。方法回顾性分析新疆医科大学第一附属医院 2006年 5月至 2011年 4月误诊的 85例肺部球形病灶患者的临床症状及影像学表现，其中男 49例，女 36例；中位年龄 58（34～75）岁。病灶位于右肺 46例，左肺 39例，直径 2.0～ 5.6 cm。术前患者均经胸部正侧位 X线片检查，并在其后 1周内追加胸部 CT检查， 76例行 CT增强扫描。经手术组织病理学检查证实 69例，经支气管镜检查证实 9例，经穿刺组织病理学检查证实 7例。结果肺癌误诊为良性疾病 36例（肺结核 18例、炎性假瘤 12例、肺炎 4例、胸膜间皮瘤 2例）；良性病变被误诊或误诊为肺癌分别为：结核球 32例被误诊为肺癌 23例、炎性假瘤 7例、肺错构瘤 2例；肺包虫 10例被误诊为肺癌 3例、肺结核 5例、炎性假瘤 2例；炎性假瘤 5例被误诊为肺癌 1例、肺结核 4例；肺错构瘤 2例被误诊为肺结核。结论仔细全面分析影像学特征并结合临床症状，合理应用检查方法，可减少肺部球形病变的误诊。