带状疱疹引起腹壁假疝一例

报道带状疱疹引起腹壁假疝1例，经腹部CT检查排除肿瘤占位、肠梗阻、腹腔积液及腹壁疝等鉴别诊断，未予治疗，3个月后随访腹壁疝明显缓解。     

带状疱疹后腹股沟斜疝1例

目的　报道 1例老年患者带状疱疹后出现腹股沟斜疝 ,分析可能由于带状疱疹运动性麻痹和本身腹壁强度降低所致 ,经抗病毒和营养神经治疗至病程 1月左右恢复正常 ;因此 ,对于受累神经在T12 L2之间老年带状疱疹患者 ,临床询问病史及查体应注意排除腹股沟疝的可能 ,以免发展为临床难治性疝 ,甚至堪顿性或绞窄性疝。     

全国接触性皮炎与皮肤变态反应诊断与治疗学习班

目的报道1例老年患者带状疱疹后出现腹股沟斜疝，分析可能由于带状疱疹运动性麻痹和本身腹壁强度降低所致，经抗病毒和营养神经治疗至病程1月左右恢复正常；因此，对于受累神经在T12-L2之间老年带状疱疹患者，临床询问病史及查体应注意排除腹股沟疝的可能，以免发展为临床难治性疝，甚至堪顿性或绞窄性疝。     

寻常性银屑病伴发带状疱疹4例报告

近期 ,我们诊治了 4例寻常性银屑病伴发带状疱疹的患者 ,现报告如下。临床资料　 4例中男 3例 ,女 1例 ,年龄 35～ 6 5岁 ,银屑病史 2～ 30年 ,均反复发作。在本次发生带状疱疹时 ,处于寻常性银屑病进行期 1例 ,静止期 2例 ,退行期 1例。此前均已进行了长期的抗银屑病治疗 ,进行期及静止期的 3例患者均治疗 3个月以上 (其中进行期患者已治疗 6个月 ) ,但疗效欠佳 ,而退行期患者带状疱疹发生在经过治疗痊愈后 1周。发生带状疱疹后 ,除继续原有的抗银屑病治疗外 ,分别给予阿昔洛韦 (1ｇ/ｄ静滴 ,共 5～ 7天或 1ｇ/ｄ口服 ,共 7天 )、维生素Ｂ1…     

带状疱疹455例临床分析

目的分析带状疱疹发病年龄、平均住院日、神经痛与皮疹出现的先后顺序、其临床类型、并发症、误诊情况、发病季节及后遗神经痛的关系。方法对1999~2004年455例带状疱疹住院患者进行临床分析。结果带状疱疹平均发病年龄51岁,平均住院13天,先出现神经痛者198例(43.52%),临床类型:普通型368例(80.88%),特殊型87例(19.12%),带状疱疹并发肿瘤9例(1.98%),并发皮肤细菌感染者34例(7.47%);带状疱疹发病早期误诊65例(14.29%);后遗神经痛发生56例(17.18%),发病季节无明显差异。结论带状疱疹发病男性多于女性,60岁以上患者易发生后遗神经痛。     

带状疱疹186例临床分析

目的观察、分析门诊带状疱疹患者的发病诱因、年龄、部位、神经痛与皮疹出现的关系、临床类型、并发症、发病季节、病程、及后遗神经痛的发生情况。方法对1995年~2005年186例门诊带状疱疹病例进行统计分析。结果带状疱疹有明显诱因123例(66.13%),平均发病年龄56岁,先出现神经痛者139例(74.73%),临床类型:普通型157例(84.41%),特殊型29例(15.59%),发病早期误诊27例(14.52%),后遗神经痛发生23例(12.37%),发病季节以春、冬季居多。结论带状疱疹多数有诱发因素,男性多于女性,春冬季好发,中年人居多,61岁以上年龄段及未用激素治疗者易发生后遗神经痛。     

人免疫缺陷病毒阳性带状疱疹27例临床分析

目的探讨感染人免疫缺陷病毒(HIV)带状疱疹患者的临床特征。方法回顾性分析2013年1月—2014年10月收治的HIV感染并发带状疱疹27例患者临床资料。结果 27例HIV感染者所有疼痛评分均3分(6.07±2.05)分,住院天数为(9.5±2.0)d,均出现了CD4+T淋巴细胞计数降低(343±49)个/μl。结论 HIV感染并发带状疱疹患者与普通带状疱疹患者相比,常常侵犯多神经支配区域,疼痛明显,临床表现更为严重,治疗时间相对较长,CD4+T淋巴细胞计数降低可能是带状疱疹的发生及复发的重要因素。     

带状疱疹性脑炎1例

带状疱疹发病率较高,并发症多见,但并发脑炎者少见.现将我们诊治的1 例带状疱疹性脑炎患者结合文献报道分析报告如下. 1 病历摘要 患者男,76 岁.因左侧额面部皮损伴疼痛1 个月余,于2011年2 月就诊我科.患者1个月前无明显诱因左侧额部、左上眼睑出现散在蚕豆大片状红斑,其上见粟粒至芝麻大簇集性水疱伴轻微跳痛、灼痛,患者于当地接受输液治疗4 d 后,改口服中药治疗(具体药物不详),起病10 d 后红斑变淡,水疱疱液吸收,表面干涸结痂,但左侧眼部灼痛瘙痒无明显减轻,视物出现重影,入院前1 d曾到眼科检查示左眼外展受限,排除其他眼病,考虑"带状疱疹性眼病".     

创伤后计划性腹疝确定性重建的新方法——改良腹直肌推徙术

目的探讨开放腹腔手术后巨大计划性腹疝的新的手术方式改良腹直肌推徙术的治疗效果。方法总结分析12例巨大计划性腹疝患者的临床资料和改良腹直肌推徙术的治疗结果。其中,男9例,女3例,平均41．5岁。术前合并结肠造口5例;回肠造口2例;胰瘘1例;胃空肠吻合口一腹壁瘘1例;慢性胆囊炎1例。计划性腹疝至确定性重建的时间平均为6．5个月。结果本组12例患者手术后救治成功12例（成功率100％）,术后发生皮下血清肿1例,皮缘坏死2例,经引流及换药治愈。术后无严重感染并发症,无复发性腹腔间隙综合征发生,无脏器功能障碍发生。腹直肌功能恢复良好,无其他不适症状。随访2～25个月,平均13．6个月,轻度复发1例。结论改良腹直肌推徙术治疗巨大计划性腹疝,方法实用,操作简单,效果良好,为开放腹腔手术后巨大计划性腹疝患者临床治疗提供了新的可供选择的手术方法。     

带状疱疹后皮肤淋巴细胞浸润1例

报告1例带状疱疹后皮肤淋巴细胞浸润，患者男，54岁，疱疹痊愈后2个月须皮损部位出现多个斑丘疹和丘疹，组织病理检查示真皮浅，中层以T淋巴细胞为主的浸润，诊断为带状疱疹继发皮肤淋巴细胞浸润，治疗3个月后皮损全部消失。     

不同术式膀胱阴道瘘修补术治疗妇科手术后膀胱阴道瘘的临床分析

目的:分析探讨不同术式膀胱阴道瘘修补术治疗妇科手术后膀胱阴道瘘的疗效。方法:回顾性分析北京大学第三医院泌尿外科2009年4月至2015年11月收治的12例膀胱阴道瘘患者的临床资料。12例患者均有妇科手术史:其中行子宫全切术10例,行盆腔肿物切除术1例,行膀胱电切术1例。从手术损伤致出现阴道漏尿的病程为5~12个月,平均8.4±2.9个月。膀胱镜检查测量瘘口直径0.3~2cm,平均(1.1±0.6)cm。12例均为单发瘘口。结果:6例患者行经阴道途径膀胱阴道瘘修补术。平均手术时间为(105.0±32.0)min,平均术中出血(4.5±1.2)mL,平均术后住院时间(3.0±1.5)d。6例患者术后6个月未见复发;3例患者行经腹腔镜途径膀胱阴道瘘修补术。平均手术时间为(345.3±192.3)min,平均术中出血(83.3±28.9)mL,平均术后住院时间(10.3±3.2)d。2例随访6月未见复发,1例术后6月发生膀胱阴道瘘复发,行二次手术修补;1例患者采用开放经腹腔途径膀胱阴道瘘修补术。手术时间为234min,术中出血200mL,术后住院时间40d。术后出现伤口脂肪液化,予定期换药治疗后好转,随访6月未见复发;1例患者发生Studer原位新膀胱阴道瘘,采用经腹经阴道联合途径的手术方式,手术时间为224min,术中出血100mL,术后住院时间20d,随访6月未见复发;1例患者因瘘口较小采用膀胱镜下膀胱阴道瘘口电凝术,手术时间为10min,术中出血2mL,术后住院时间2d,术后出现不自主漏尿,复查膀胱镜仍可见膀胱后壁瘘口,遂留置尿管1月,1月后行经阴道膀胱阴道瘘修补术,随访6月未见复发。结论:妇科手术导致的膀胱阴道瘘可以通过手术修补治愈。经阴道修补手术成功率高,术后恢复较快。对于能够经阴道显露、分离及缝合的膀胱阴道瘘尽可能行经阴道修补手术。     

九例色素减退性蕈样肉芽肿临床及病理分析

【摘要】 目的 分析9例色素减退性蕈样肉芽肿（HMF）的临床及病理学特点。方法 回顾性分析2014—2018年在杭州市第三人民医院皮肤科经临床及组织病理学确诊的9例HMF患者的临床、病理表现及随访情况。结果 9例患者中男7例，女2例；年龄6 ~ 29岁，平均12.4岁；病程最短6个月，最长3年,平均20.7个月。所有皮损均表现为色素减退斑片，边界不清，形状欠规则，部分色素减退斑融合，2例色素减退斑上覆鳞屑。Wood灯下色素减退斑呈灰白色，荧光弱；皮肤镜下皮损处可见白色鳞屑，精子样、点状或短线状血管模式；反射式共聚焦显微镜下可见基底层色素轻度减退，未见明显色素缺失，表皮及真表皮交界处可见高折光异形细胞。9例组织病理均表现为异形淋巴细胞亲表皮现象，部分可见细胞聚集成Pautrier微脓肿；免疫组化染色显示细胞表型均符合T细胞表型，以CD8+ T细胞浸润为主。9例患者采用窄谱中波紫外线（NB-UVB）治疗，均达临床痊愈。平均随访23.8个月，2例复发，再次行NB-UVB治疗，均达临床痊愈。结论 HMF病情进展缓慢，NB-UVB治疗效果较好，患者达临床痊愈后存在复发可能，均需长期随访。     

Acute alopecia totalis

From a group of 1,189 AA patients seen in our dermatology unit, thirteen (3 males, 10 females) experienced hair shedding that started profusely and diffusely over the entire scalp. They were under observation for about 5 years, histopathology and trichograms being performed in all instances. The mean age of the patients was 26.7 years. It took only 2.3 months on average from the onset of hair shedding to total denudation of the scalp. The trichogram at the time of diffuse shedding showed that about 80% had dystrophic roots and the remaining 20% had telogen roots. Histopathological findings and exclamation mark hairs were compatible with alopecia areata. Regrowth of hair was noted 3.2 month after the onset of hair shedding and recovery observed in 4.8 months. All patients were treated by methylprednisolone pulse therapy. During the follow-up period, 53 months on average after recovery, 8 of the 13 patients (61.5%) showed normal scalp hair without recurrence, in 4 patients the recovery was cosmetically acceptable in spite of focal recurrences and only 1 patient showed a severe relapse after recovery. Considering all of the above findings, this group of the patients should be delineated by the term acute alopecia totalis.     

肱骨近端内锁系统钢板逆行肱骨前路微创钢板内固定在车祸致多发性肱骨远端骨折中的手术应用

目的探究肱骨近端内锁系统(proximal humeral internal locking system,PHILOS)钢板逆行肱骨前路微创钢板内固定在车祸致多发性肱骨远端骨折中的应用价值。方法选取2016年2月-2019年2月期间,苏州高新区人民医院收治的127例车祸致肱骨远端骨折患者为研究对象,行前路微创钢板内固定和PHILOS钢板内固定治疗,评估肘关节疗效、骨折愈合情况、关节功能恢复情况及并发症的发生率。结果随访8~22个月,所有患者在12~22个月内骨折愈合,平均骨折愈合周期为(14.87±1.54)个月;术后24个月Cassebaum评分优良率86.61%(110/127),肘部平均关节活动度为(141.23±3.74)°(130~145),Mayo肘关节功能评分(Mayo elbow perfor?mance score,MEP)、加利福尼亚大学洛杉矶分校(University of California at Los Angeles,UCLA)评分较术前显著上升,差异有统计学意义(P<0.05);术后无切口感染、畸形愈合、桡神经麻痹、肱骨头坏死等并发症发生,仅肘关节僵硬2例、尺神经损伤1例。结论PHILOS钢板逆行肱骨前路微创内固定术治疗肱骨远端骨折疗效确切,骨折愈合良好,能促进肘关节功能恢复,且无感染、桡神经麻痹等并发症发生。     

Effects of relaxation therapy and hypnotizability in chronic urticaria

The therapeutic results of hypnosis with relaxation therapy were evaluated in 15 patients with chronic urticaria of 7.8 years' average duration. Compared with baseline and control session values, the hypnosis session provided relief of pruritus as measured by three self-report parameters. There was no change in the number of hives. All subjects were given a standard test for hypnotizability. Assuming that the results were not biased by their preceding relaxation sessions, we determined that six subjects were hypnotizable and nine were nonhypnotizable. Subjects in both groups improved symptomatically, but hypnotizable subjects had fewer hives and became more symptomatic during the control (testing and history taking) session. Hypnotizable subjects also more frequently related stress as a causative factor. At a follow-up examination five to 14 months after the completion of the experimental sessions, six patients were free of hives and an additional seven reported improvement.     

(13) Tolerance of spironolactone

In recent years, the anti-androgenic properties of spironolactone have been used in the treatment of acne and hirsutism. Consequently, the drug has been used for a younger population of patients and also at a higher dose.
Forty-four patients (43 female and 1 male), mean age 37 years (range 28–50 years), who had been treated with spironolactone, were reviewed to determine their tolerance of the drug. Treatment was commenced at 200 mg daily. The average duration of treatment was 14 months (range 1–45 months).
The most common side-effect was disturbance of menstruation (66%). Ten patients had irregular periods; 11, intermenstrual bleeding; 10, ammenorrhoea; eight, lighter blood loss during periods; two, heavier periods; and seven, more frequent periods.
Twenty-seven per cent complained of breast enlargement and 30% of breast tenderness; 18% complained of nausea; 39% admitted to having dry skin. Four patients experienced this symptom severely enough to produce itching and scaling. Two patients complained of abnormal facial pigmentation resembling chloasma—a previously unreported side-effect of spironolactone.
Other less common side-effects were vomiting, dizziness, drowsiness, headaches, abdominal pain, loss of short-term memory and malaise.
Side-effects tended to occur early and persist throughout treatment and were managed in some cases by alteration of the dose of the drug. Only four patients withdrew from treatment. The patients tolerated the side-effects well, despite the high incidence, in view of the drug's beneficial effects.     

动脉性阳痿显微重建37例

目的：动永陆阳痿主要是阴茎动脉供血不足或缺乏所致。由于缺血、缺氧对阴茎输入、输出血管壁肉垫易纤维化,失去正常开放与舒张功能,进而加重了阳痿。通过动脉重建以改善阴茎供血、供氧,促使受损组织得以康复。方法：运用显微外科技术作腹壁下动脉-海绵体吻合2例;与阴茎背动脉端端、端侧吻合10例;与阴茎背深静脉端端吻合25例。本组采取端端、端侧、套入、血管移植等方法,全部作阴茎背深、脚静脉结扎。结果：术后随访5—60个月显效20例,占54．05％;满意12例,占32.34％;无效5例,占13．51％。结论：动脉性阳痿,不仅阴茎供血不足造成损害,而且影响或加重静脉系统关闭不全,一旦发生器质性改变,手术效果将不够理想。笔者主张动脉性阳痿尽早作动脉重建是较为理想的选择。     

Multiple synchronous cutaneous melanomas: implications for prevention

BACKGROUND: A subset of about 3-5% of melanoma patients present a second primary melanoma. OBSERVATIONS: We describe two cases of primary multiple synchronous melanomas consecutively observed in the last 6 months in our department in two male patients presenting multiple atypical nevi. In both patients, the second melanoma was diagnosed by the clinician who had identified the first one, but at the time of the first follow-up consultation, 3 months later. The delayed discovery of the second melanoma required another referral for surgery with additional discomfort for the patients. Concern about the first lesion (the thickest in both cases) probably rendered the second one less evident to both patients and clinician, until the first follow-up examination after excision of the first lesion. CONCLUSION: We stress the need for careful and thorough examination of the whole body surface at the time of detection of a cutaneous melanoma in subjects with multiple atypical moles because the finding of synchronous multiple melanomas is not uncommon.     

ITRACONAZOLE IN THE TREAMENT OF CHROMOBLASTOMYCOSIS DUE TO FONSECAEA PEDROSOI

The efficacy and tolerability of itraconazole in chromoblastomycosis due to Fonsecaea pedrosoi were evaluated in a non-comparative open clinical trial in 19 Brazilian patients with histopathologically and mycologically proven active chromoblastomycosis. Patients were classified in terms of severity and received itraconazole at the dosage of 200 to 400 mg per day until previously described criteria of cure have been reached. Clinical, mycologic, histopathologic, and laboratory evaluations were performed before, during, and after therapy. The plasma levels of itraconazole and the in vitro susceptibility of the isolates were determined in 15 cases. Clinical and biologic cure were achieved by eight patients (42%) having mild to moderate disease, after a mean duration of therapy of 7.2 months (3.2-29.6 months). Sterile scarred lesions were observed in a post-therapy follow-up lasting on average 9.6 months that was carried out in this subgroup. Clinical cure alone occurred after a mean period of 25.1 months of treatment (16-30.5 months) in seven patients (36%) with moderate to severe disease. Finally, clinical improvement was obtained in four patients (21%) with severe lesions after a mean treatment time of 17.6 months (10.7-22.5 months). All patients responded favorably to itraconazole therapy. No significant side effects nor biochemical alteration during this trial were important enough to interrupt the treatment. Our results support those of previous trials, suggesting that itraconazole is an effective compound against chromoblastomycosis due to Fonsecaea pedrosoi.