The Theoretic Exploration On "Counter-clinical Thought" And Its Application In Study On The Emerging Diseases Caused By Etiological Organisms

This project consists of three parts:1. Exploration on "counter-clinical thought" and methods of finding of the emerging diseases, in which thought manner of finding of the emerging diseases was discussed theoretically.2. Finding and determination of "acute hemorrhagic appendicitis", in which "counter-clinical thought" was used to analyze and determine the manifestation of the emerging diseases, namely, " acute hemorrhagic appendicitis".3. Study on etiology of "acute hemorrhagic appendicitis", in which systematic methods were used to detect potential infectious agents associated with "acute hemorrhagic appendicitis".Chapter 1. Exploration on "counter-clinical thought" and methods of finding of the emerging diseasesObjective: To raise preliminarily new manner of medical thought (temporarily call "counter-clinical thought") and methods of finding of emerging diseases.Methods: Review process of finding of more than 20 diseases and summarize common regular pattern.Results: Process and thought manner of finding of emerging diseases may be generalized as follows: 1. Take unexpected abnormal features as clues of finding of emerging diseases, which includes the 3 following areas: epidemiologic, clinical manifestation and results of laboratory examination. 2. Study methods and process on finfding of emerging diseases. Epidemiologic, clinical and laboratory data should be collected comprehensively following finding of clues. 3. Suggestion of judgement on emerging diseases: (1) Application of macrothought to mass. Clinical thought was applied to individual patient one by one. Because individual differences exist between patients, it is difficult to distinguish the emerging diseases from individual differences between the patients with known diseases. While "counter-clinical thought" attaches importance to common features derived from different individuals including epidemilogic, clinical features and laboratory examination and analyzed these features all-round, which conducive toexclusion of individual differences between patients and determine existence of the emerging disease. (2) Application of induction. Clinical thought belongs to deduction, namely, compares disease features derived from individual with diagnosis standards of known diseases and lays stress on similar features to known diseases. While "counter-clinical thought" attaches importance to not only same features as but also different features from known diseases further, especially to change of features which have diagnosis value. The more change of these feature there are, the more possibility of emerging diseases there are. (3) Pay attention to finding ermerging diseases from known diseases (4) Combination of study on etiology. Discovery of new etiologic agent is conducive to judgement on emerging diseases. (5) Exclusion of the known diseases. In this aspect, clinical thought is necessary.Conclusion: Patterns of thought of finding of emerging diseases is different from classic patterns of clinical thought.Chapter 2. The finding and determination of "acute hemorrhagic appendicitis"Objective: To examine features of a cluster of acute appendicitis that occurred among a high school student population in China.Methods: Epidemiological data, medical records and histological slides of resected appendices were examined.Results: During a period between April 10, 1997 and June 11, 1997, 1 leases occurred in a high school, with 10 cases among 290 students enrolled at the time. From the end of the initial cluster until June, 2000, 20 additional cases were encountered. Female cases (6.5%) are more frequent than male cases (1.9%). There was a clustering pattern. Many patients had a history of mutual contact before the onset of symptoms. Pathologically, the resected appendices exhibited diffuse or focal hemorrhages in the lamina propria or within hyperplastic lymphoid follicles, and infiltration by eosinophils, and by lymphocytes.Conclusion: This cluster of acute appendicitis represented a special kind of appendicitis, with features of an infectious disease in epidemiology.Chapter 3. Study on the potential infectious agents of " acute hemorrhagic Appendicitis "Objective: To detect the potential infectious agents of "Acute HemorrhagicAppendicitis ".Methods: Materials include serum samples and appendical tissues from each person of 11 cases with "acute hemorrhagic appendicitis" and 8 cases with common appendicitis. Gram stain, silver stain and Giemsa stain were used to detect appendiceal tissues of the above cases. Serological method were used to detect IgM against adenovirus, IgM against Coxsackie virus and IgG against Hantavirus. Immunohistochemical technique were used to screen for antigen of enterovirus and antigen of adenovirus using monoclonal antienterovirus clone 5-D8 and monoclonal antiadenovirus group. PCR were used to detect RNA of enterovirus and DNA of adenovirus.Results: Spirochetes , fungi and parasites were not found with Silver stain and Giemsa stain . There was no difference of bacterial features in the above two kinds of appendicitis. Distribution of bacterials was not coincident with distribution of hemorrhage of appendices. Serological detection were nagative for IgM against adenovirus, IgM against Coxsackie and IgG against Hantavirus. Immunohistochemistry test for adenovirus was nagtive for appendical tissue section from all 11 cases with "acute hemorrhagic appendicitis" and 8 cases with classical acute appendicitis. Immunohistochemistry test for enterovirus was positive for appendical tissue section from 6 of 11 cases with "acute hemorrhagic appendicitis" and 4 of 8 cases with classical acute appendicitis. PCR examination showed nagative results after ampification of RNA of enterovirus and DNA of Yersinia enterocolitica.Conclusion: Occurrence of "Acute hemorrhagic appendicitis" is probably not associated with spirochetes , fungi ,parasites, known bacterial and known virus, and may be caused by a new infectious agent.