结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

Sjögren's syndrome

Validity and Reliability of the Reflux Symptom Index (RSI)

The epidemiology of human papillomavirus infections.

Background There is a need for more research on all forms of rhinosinusitis. Progress in this area has been hampered by a lack of consensus definitions and the limited number of published clinical trials. Objectives To develop consensus definitions for rhinosinusitis and outline strategies useful in clinical trials. Methods Five national societies, The American Academy of Allergy, Asthma and Immunology; The American Academy of Otolaryngic Allergy; The American Academy of Otolaryngology Head and Neck Surgery; The American College of Allergy, Asthma and Immunology; and the American Rhinologic Society formed an expert panel from multiple disciplines. Over two days, the panel developed definitions for rhinosinusitis and outlined strategies for design of clinical trials. Results Committee members agreed to adopt the term "rhinosinusitis" and reached consensus on definitions and strategies for clinical research on acute presumed bacterial rhinosinusitis, chronic rhinosinusitis without polyposis, chronic rhinosinusitis with polyposis, and classic allergic fungal rhinosinusitis. Symptom and objective criteria, measures for monitoring research progress, and use of symptom scoring tools, quality-of-life instruments, radiologic studies, and rhinoscopic assessment were outlined for each condition. Conclusion The recommendations from this conference should improve accuracy of clinical diagnosis and serve as a starting point for design of rhinosinusitis clinical trials.

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Rhinosinusitis: Establishing definitions for clinical research and patient care

Objectives:The Eating Assessment Tool is a self-administered, symptom-specific outcome instrument for dysphagia. The purpose of this study was to assess the validity and reliability of the 10-item ...

Validity and reliability of the Eating Assessment Tool (EAT-10).

Background The evaluation of medical and surgical outcomes relies on methods of accurately quantifying treatment results. Currently, there is no validated instrument whose purpose is to document the physical findings and severity of laryngopharyngeal reflux (LPR). Objective To evaluate the validity and reliability of the reflux finding score (RFS). Methods Forty patients with LPR confirmed by double-probe pH monitoring were evaluated pretreatment and 2, 4, and 6 months after treatment. The RFS was documented for each patient at each visit. For test-retest intraobserver reliability assessment, a blinded laryngologist determined the RFS on two separate occasions. To evaluate interobserver reliability, the RFS was determined by two different blinded laryngologists. Results The mean age of the cohort was 50 years (+/- 12 standard deviation [SD]). Seventy-three percent were women. The RFS at entry was 11.5 (+/- 5.2 SD). This score improved to 9.3 (+/- 4.7 SD) at 2 months, 7.3 (+/- 5.5 SD) at 4 months, and 6.1 (+/- 5.2 SD) at 6 months of treatment (P Conclusions The RFS accurately documents treatment efficacy in patients with LPR. It demonstrates excellent inter- and intraobserver reproducibility.

The Validity and Reliability of the Reflux Finding Score (RFS)

Background: Patients with laryngopharyngeal reflux (LPR) undergoing treatment appear to have improvement in symptoms before the complete resolution of the laryngeal findings Objective: To determine whether patients with LPR experience an improvement in symptoms before the complete resolution of the laryngeal findings Methodology: Forty consecutive patients with LPR documented by double-probe pH monitoring were evaluated prospectively Symptom response to therapy with proton pump inhibitors was assessed at 2, 4, and 6 months of treatment with a self-administered reflux symptom index (RSI) In addition, transnasal fiberoptic laryngoscopy (TFL) was performed and a reflux finding score (RFS) was determined for each patient at each visit Results: The mean RSI at entry was 193 (± 89 standard deviation) and it improved to 139 (± 88) at 2 months of treatment (P <05) No further significant improvement was noted at 4 months (131 ± 98) or 6 months (122 ± 81) of treatment The RFS at entry was 115 (± 52), and it improved to 94 (± 47) at 2 months, 73 (± 55) at 4 months, and 61 (± 52) after 6 months of treatment (P <05 with trend) Conclusions: Symptoms of LPR improve over 2 months of therapy No significant improvement in symptoms occurs after 2 months This preliminary report demonstrates that the physical findings of LPR resolve more slowly than the symptoms and this continues throughout at least 6 months of treatment These data imply that the physical findings of LPR are not always associated with patient symptoms, and that treatment should continue for a minimum of 6 months or until complete resolution of the physical findings

Laryngopharyngeal Reflux Symptoms Improve Before Changes in Physical Findings

Objectives/Hypothesis:

To define the prevalence of tracheotomy tube complications and evaluate risk factors (RFs) associated with their occurrence.



Study Design:

Multi-institution historical cohort.



Methods:

Data regarding tracheotomy tube complications from consecutive surgeries performed across eight participating institutions between January 1, 2008 and December 31, 2009 were retrospectively collected. Patient demographics, comorbidities, physician specialty, and surgical technique were recorded and statistically analyzed to identify the incidence of surgical complications following tracheotomy and associated RFs.



Results:

The charts of 1,175 tracheotomy procedures were reviewed from eight academic institutions. Otolaryngologists performed 66.2% of the tracheotomies. Intraoperative, early ( 7.5) and obesity were associated with the development of airway stenosis (P < .05).Twenty-two percent of patients undergoing tracheotomy died during hospitalization.



Conclusions:

Perioperative tracheotomy complications are rare; however, the rate of death for all causes is high (22%) in this population. Obesity and the use of endotracheal tubes over 7.5 in size are major risk factors for the development of airway stenosis. Although percutaneous tracheotomy resulted in a significantly higher rate of postoperative bleeding (6.6%) than the open method (1.9%) (P < .05), the use of outer flange tracheostomy tube sutures may reduce this complication.Laryngoscope, 122:38–45, 2012

Peter C. Belafsky

Papers

Validity and Reliability of the Reflux Symptom Index (RSI)

Validity and reliability of the Eating Assessment Tool (EAT-10).

The Validity and Reliability of the Reflux Finding Score (RFS)

Laryngopharyngeal Reflux Symptoms Improve Before Changes in Physical Findings

A multi-institutional analysis of tracheotomy complications.