早期临床干预对男性泌尿生殖系急性损伤患者性功能影响

目的探究采取早期临床干预对男性泌尿生殖系急性损伤患者性功能的影响。方法选取2015年1月至2018年12月宁波市鄞州人民医院诊治的204例男性泌尿生殖系急性损伤患者作为研究对象。随机分为干预组(n=102)和对照组(n=102)。对照组给予对症支持和手术治疗,干预组在对照组的基础上,对患者性功能进行早期临床干预。观察两组治疗后血清雌二醇(E 2)、催乳素(PRL)、促卵泡激素(FSH)、睾酮(T)水平,采用中国早泄患者性功能评价表(CIPE)和国际勃起功能指数-5(IIEF-5)问卷表评价患者性功能情况。结果干预组治疗2个月后E 2水平显著低于对照组,PRL、FSH、T水平均显著高于对照组,差异具有统计学意义(P<0.05)。干预组治疗6个月后性欲、勃起硬度频度、勃起控制时间、插入至射精时间、延长性交时间难度、性生活满意度和以上6个维度合计评分,以及IIEF-5评分均显著高于对照组,差异具有统计学意义(P<0.05)。结论应用早期临床干预能促进男性泌尿生殖系急性损伤患者预后性功能的恢复。     

慢性心衰对男性性激素水平及性功能的影响

目的:探讨男性慢性心力衰竭对性激素水平及性功能的影响,以期寻找出最佳的方法提高临床诊治水平。方法:选取2010年2月至2013年2月34例慢性心力衰竭患者为研究对象,称为研究组,且根据心功能分级分成3级;另外选取同时期的健康体检患者35例作为对照组,对两组患者均进行性激素水平检测,观察在性功能指标上的差异性。结果:在性激素水平上,对照组和研究组在性激素水平E2、T和E2/T比较差异有统计学意义(P0.05),而在性欲频度、性交频度、阴茎勃起力度、性高潮获得率、性交失败率比较差异有统计学意义(P0.05),且在研究组内,心功能Ⅱ级和Ⅲ级、Ⅲ级和Ⅳ级、Ⅱ级和Ⅳ级之间比较差异也有统计学意义(P0.05)。结论:慢性心力衰竭患者本身性激素水平会下降,也会降低患者性功能水平,且心功能等级越高,则性功能越差。     

腹腔镜直肠癌根治术中保留Denonvilliers筋膜对男性性功能的影响研究

目的:观察腹腔镜直肠癌根治术中保留Denonvilliers筋膜对男性性功能影响性。方法:收集2010年5月至2015年1月106例男性直肠癌患者临床资料,均予腹腔镜直肠癌根治术治疗,根据术中是否保留Denonvilliers筋膜分成两组,每组53例,观察不同方式对男性性功能和排尿功能影响性。结果:排尿功能上,治疗后对照组自由尿流率、排尿量较治疗前显著下降,残尿量显著升高(P0.05),研究组治疗前后比较差异不显著(P0.05),治疗后研究组显著优于对照组(P0.05);性功能上,对照组术后6个月、术后12个月勃起功能障碍率分别为24.53%、16.98%,射精障碍率为24.53%、15.09%,研究组术后6个月、术后12个月勃起功能障碍率分别为9.44%、7.55%,射精障碍率为9.44%、5.66%,研究组显著低于对照组(P0.05)。结论:腹腔镜直肠癌根治术中保留Denonvilliers筋膜能降低对男性性功能影响性。     

采用非典型抗精神病药物治疗的男性精神分裂症患者勃起功能和血清催乳素水平的相关性研究

目的探究采用非典型抗精神病药物治疗的男性精神分裂症患者勃起功能和血清催乳素水平的相关性。方法选取2018年2月至2019年2月湖北省恩施州民族医院诊治的400例男性精神分裂症患者作为研究对象,根据简明性功能障碍自评量表评估结果,将性功能障碍患者纳入障碍组(n=173),无性功能障碍患者纳入无障碍组(n=227)。检测血清催乳素水平,并对性功能、精神病症状、副作用进行评估,探讨血清催乳素与性功能、精神病症状、副作用水平的相关性。结果障碍组血清催乳素水平显著高于无障碍组,差异具有统计学意义(P0.05)。Pearson相关性分析显示,血清催乳素水平与国际勃起功能指数-15(IIEF-15)的勃起功能评分呈正相关(P0.05),与副作用量表评分呈负相关(P0.05),与IIEF-15总分和其他因子评分以及简明精神病量表评分均无明显关联(P0.05)。结论血清催乳素水平与男性精神分裂症患者采用非典型抗精神病药物所致性功能障碍存在一定的相关性,在指导临床治疗和评价非典型抗精神病药物所致性功能障碍的危险度中有一定的应用价值。     

微创手术治疗血精症对性功能的影响观察分析

目的:探讨微创手术治疗血精症对性功能的影响,以期丰富治疗方法。方法:选取2012年2月至2015年2月血精症患者50例作为研究组,予内镜微创治疗;选取同时期血精症患者50例作为对照组,予中医药治疗,观察两组治疗前后在性功能指标、疗效和性生活质量等方面变化。结果:疗效上,对照组治愈率20%、总有效率78%,研究组治愈率38%、总有效率92%,治愈率和总有效率研究组显著高于对照组,两组比较差异显著(P0.05);两组治疗后精液常规的红细胞、白细胞和前列腺液中白细胞较治疗前均显著下降,卵磷脂小体显著升高,治疗前后比较差异显著(P0.05),研究组治疗后在以上指标较对照组治疗后改善更加显著,两组治疗后比较差异显著(P0.05);两组治疗后性欲、勃起功能、射精功能、问题评估、本人满意度、性伴侣满意度及总分较治疗前均显著下降,治疗前后比较差异显著(P0.05),研究组治疗后在以上指标较对照组治疗后下降更加显著,两组治疗后比较差异显著(P0.05)。结论:内镜微创治疗血精症疗效满意,能提高性功能。     

后腹腔镜肾盂切开取石术对男性肾盂结石患者血液流变学与性功能指标的影响

目的探讨后腹腔镜肾盂切开取石术对男性肾盂结石患者血液流变学、性功能等指标的影响。方法选取2016年10月至2019年1月广安市人民医院诊治的82例男性肾盂结石患者作为研究对象。按照随机数字表法分为研究组(n=41)与对照组(n=41)。对照组采取经皮肾镜取石术(PCNL),研究组采取后腹腔镜肾盂切开取石术(RLP)。统计两组应激反应、血液流变学、性功能指标评分,以及并发症情况。结果术后1 d两组皮质醇(Cor)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)水平较术前明显增高,但研究组各指标水平低于对照组,差异具有统计学意义(P<0.05)。术后1 d两组全血低切及高切黏度、血浆黏度、血细胞比容均较术前明显增高,但研究组各指标水平低于对照组,差异具有统计学意义(P<0.05)。术后2个月两组国际前列腺症状评分(IPSS)、中国早泄患者性功能评价表-5(CIPE-5)评分较术前增高,而国际勃起功能指数5(IIEF-5)评分较术前降低,差异具有统计学意义(P<0.05),但组间比较,差异无统计学意义(P>0.05);术后4个月两组IPSS、CIPE-5较术前降低,IIEF-5评分较术前升高,差异具有统计学意义(P<0.05),但组间比较,差异无统计学意义(P>0.05)。研究组并发症发生率低于对照组,差异具有统计学意义(P<0.05)。结论采取RLP治疗肾盂结石创伤小,围术期应激反应程度较轻,可减少对血液流变学及性功能造成的影响,利于术后性功能早期康复,且并发症少,具有安全性。     

中年慢性前列腺炎患者性生活状况调查

目的:调查慢性前列腺炎(CP)患者性生活质量状况并分析影响性生活质量的相关因素。方法:随机选择有稳定规律性生活的CP患者152例,并选择152例健康中年男性为比较对象,分别计算两组患者美国国立卫生研究院慢性前列腺炎症指数评分表(NIH-CPSI)、中国早泄患者性功能指数-5(CIPE-5)、国际勃起功能指数-5评分表(IIEF-5)分数及患者一般临床资料,对照分析患者性功能、患者及其配偶性生活质量状况。结果:CP组与对照组相比患者性欲、勃起及勃起维持能力、射精及射精控制能力、性高潮频度、性生活焦虑紧张程度、性生活自信度等评分、患者及其配偶性生活满意度评分、配偶性高潮频度评分等均显著下降(P0.05)。结论:CP患者性功能各项指标较对照组均显著偏低;性功能障碍显著影响了患者及其配偶的性生活质量;而患者性功能下降及性生活下降主要由CP症状造成的。     

低强度体外冲击波联合药物治疗对勃起功能障碍患者临床症状及性功能的影响

目的探讨低强度体外冲击波(ESW)联合药物治疗对勃起功能障碍(ED)患者临床症状及性功能的影响。方法选取2015年6月至2017年1月武汉市汉阳医院泌尿外科(湖北省泌尿外科疑难病例会诊中心)收治的124例ED患者作为研究对象。按照随机数表分为联合组与对照组各62例。对照组患者仅口服他达拉非治疗,联合组患者则在其基础上联合低强度ESW进行治疗。比较治疗前及治疗2个月后,两组患者夜间阴茎胀大试验(NPT)指标(平均有效勃起次数、平均每次勃起时间、平均勃起硬度)、性功能[国际勃起功能指数量表-专项维度(IIEF-EF)、简明男性性功能量表(BMSFI)]、性唤起时海绵体深动脉血流动力学参数[收缩期峰值血流速度(PSV)、搏动指数(PI)]、信使分子分泌水平[血清一氧化氮(NO)、一氧化氮合酶(NOS)]及精液常规检查指标(精子密度、精子活率)水平变化,分析治疗2个月内两组患者药物不良反应发生情况差异。结果治疗2个月后,两组患者NPT指标(平均有效勃起次数、平均每次勃起时间、平均勃起硬度)、性功能评分(IIEF-EF评分、BMSFI评分)、性唤起时海绵体深动脉血流动力学参数水平及信使分子分泌水平均较治疗前有显著提升,且联合组明显高于同期对照组,差异均具有统计学意义(均P0.05);两组患者精子密度、精子活率均较治疗前无明显变化,且组间比较均无统计学意义(均P0.05)。治疗2个月内,两组患者药物不良反应发生率比较无统计学意义(P0.05)。结论低强度ESW联合药物治疗ED效果显著,可有效缓解患者临床,对其预后性功能复旧有利。     

显微取精术对无精子症患者性功能的影响

目的:研究非梗阻性无精子症患者行睾丸显微取精术后,患者血清性激素水平和性功能的变化。方法:采用自身对照的方法 ,从我院拟行辅助生殖助孕的患者中筛选出98例非梗阻性无精子症患者,行睾丸显微取精术,手术前及术后3个月分别进行血清性激素水平检测同时采用国际勃起功能指数调查问卷(IIEF-5问卷)评价受试者的勃起功能状况,并进行对比分析。结果:(1)手术前后患者体内的性激素(FSH、LH、Tr)水平差异无统计学意义(P0.05);(2)患者的勃起功能指数在治疗前后差异有统计学意义(P0.05);(3)两组患者焦虑、抑郁评分在治疗前后相比差异有统计学意义(P0.05)。结论:睾丸显微取精术并未对患者体内的性激素水平造成明显影响,但手术给患者的勃起功能以及心理状况有显著性的影响。     

不同直肠癌手术术式男性患者术前术后勃起功能状况调查分析

目的:探讨不同直肠癌手术术式对男性患者术前术后勃起影响,以期提高临床诊治水平。方法:选取2010年2月至2014年2月176例直肠癌患者为研究对象,分成两组,对照组88例,予开腹直肠癌根治术,观察组88例,予腹腔镜治疗,观察治疗前后在勃起及射精功能的变化情况。结果:在勃起和射精功能上,术前比较差异无统计学意义(P0.05),对照组治疗后6个月、12个月和治疗前比较射精功能均有下降,但治疗后6个月与治疗前后比较差异无统计学意义,治疗后12个月和治疗前比较差异有统计学意义(P0.05),观察组治疗前和治疗后6个月、12个月比较差异无统计学意义(P均0.05);对照组治疗后6个月、12个月较治疗前IIEF-5评分有下降,治疗前后比较差异有统计学意义(P均0.05),观察组治疗前和治疗后6个月、12个月IIEF-5评分比较差异无统计学意义(P均0.05),治疗后6个月、12个月两组IIEF-5评分比较差异有统计学意义(P0.05)。对两组治疗前后射精功能进行比较,术前比较差异无统计学意义(P0.05)。结论:腹腔镜根治术对直肠癌术后性功能影响性较低,总体上能改善生活质量。     

Occupational allergic contact dermatitis caused by decorative plants

12 cases of occupational allergic contact dermatitis caused by decorative plants were diagnosed in a 14-year period. The patients were middle-aged, and their average exposure time was 13 years. The plant families and plants causing occupational contact dermatitis were Compositae (5 patients: chrysanthemum, elecampane, gerbera, feverfew), Alstroemeriaceae (5 patients, Alstroemeria ), Liliaceae (4 patients; tulip, hyacinth). Amaryllidaceae (2 patients: narcissus) and Caryophyllaceae (2 patients; carnation, cauzeflower). The known chemical allergens causing dermatitis were tuliposide-A and sesquiterepene lactones, such as alantolactones and parthenolide, in the Liliaceae and Compositae families. 7 of the 12 patients were able to continue their work; 5 were not because of severe relapses of skin symptoms. The plant allergen and extract series currently available are of great help in the diagnosis.     

Metástasis cutáneas de tumores sólidos. Estudio descriptivo retrospectivo

Introduction

Cutaneous metastases are a rare event compared with other metastases. Their incidence is estimated between 0.7% and 9% of patients with cancer. Their presence always indicates a disseminated malignant disease and could also be the first manifestation of a tumor, appearing simultaneously or after a diagnosis of cancer.

Objectives

To describe the epidemiological and clinical characteristics of cutaneous metastases in our hospital.

Material and method

We performed an observational retrospective study. We included all patients with cutaneous metastases diagnosed in the Dermatology Service of our hospital during a 7-year period. Patients with metastases from sarcomas, melanomas and hematologic malignances were excluded.

Results

We studied 102 patients with cutaneous metastases. The primary tumor was identified in 87 patients (85%). The most frequent tumors were breast cancer in women (48%) and lung cancer in men (11%). Cutaneous metastases were the first sign of malignancy in 12 patients (11%). The predominant clinical form was the nodular form. The most common localization of the metastases was the thoracic region. The most common histologic diagnosis was adenocarcinoma. The mean survival after the development of metastases was 22.1 months.

Conclusion

There is an association between the frequency of cutaneous metastases and the most frequent malignancies in each sex.Our results were similar to those of other studies regarding age, sex distribution, the predominant clinical form, location, and histological diagnosis of cutaneous metastases.     

Skin microbiome and acne vulgaris: Staphylococcus,a new actor in acne

Propionibacterium acnes (P. acnes), the sebaceous gland and follicular keratinocytes are considered the three actors involved in the development of acne. This exploratory study investigated the characteristics of the skin microbiota in subjects with acne and determined microbiota changes after 28 days of application of erythromycin 4% or a dermocosmetic. Skin microbiota were collected under axenic conditions from comedones, papulo‐pustular lesions and non‐lesional skin areas from subjects with mild to moderate acne according to the GEA grading using swabs. Samples were characterized using a high‐throughput sequencing approach that targets a portion of the bacterial 16S rRNA gene. Overall, microbiota samples from 26 subjects showed an overabundance of Proteobacteria and Firmicutes and an under‐representation of Actinobacteria. Staphylococci were more abundant on the surface of comedones, papules and pustules (P=.004 and P=.003 respectively) than on non‐lesional skin. Their proportions increased significantly with acne severity (P<.05 between GEA‐2 and GEA‐3). Propionibacteria represented less than 2% of the bacteria on the skin surface. At Day 28, only the number of Actinobacteria had decreased with erythromycin while the dermocosmetic decreased also the number of Staphylococci. A significant reduction (P<.05) from Day 0 of comedones, papules and pustules with no significant difference between the products was observed. The bacterial diversity on all sampling areas was similar. The dermocosmetic decreased the number of Actinobacteria and Staphylococcus spp. after 28 days. Staphylococcus remained the predominant genus of the superficial skin microbiota. No significant reduction in Staphylococcus spp. was observed with the topical antibiotic.     

Einsatz und Bedeutung von Ciclopirox‐Lack

Summary: Onychomycosis is a common disease all over the world. Epidemiological surveys estimate the share of nail fungi at 30 % in superficial mycoses. Patients regard this disease as annoying and restrictive with regard to daily activities and social contacts. Since the beginning of the 1990ies modern treatment strategies have been developed. Among oral drugs topical lacquers like ciclopirox 8 % nail lacquer – which is approved in 45 countries of the world – play an important role in the treatment of onychomycosis. Ciclopirox nail lacquer is approved for the treatment of all types of onychomycosis. Its mode of action is fungicidal and sporocidal. The efficacy has been proven in numerous studies including all potential fungi responsible for the infection of the nail plate and in different patient populations. Due to the different mode of action compared to the azoles – ciclopirox does not impact the ergosterole synthesis – ciclopirox is an ideal combination partner for oral antimycotics. Ciclopirox nail lacquer is applied with a brush. This makes it easy to use. Adverse events were rarely reported and are of local nature.     

Curettage and colour—A technique for defining tumour depth on the ear in the Mohs and non-Mohs setting

For tumours of the ear that are suspected to involve auricular cartilage, precise definition of the extent of involved deep margin can be difficult. As large resections of cartilage can be cosmetically disfiguring with limited repair options, we propose a simple and effective technique to facilitate a targeted deep margin resection using a curette and a surgical marking pen.     

Skin elasticity in localized scleroderma (morphoea). Introduction of a biaxial in vivo method for measurement of tensile distensibility, hysteresis, and resilient distension of diseased and normal skin

A method for measuring skin elasticity in vivo based on repeated applications of suction to a circular skin area with a diameter of 10 mm and measurement of tensile distensibility (TD), hysteresis (H), and resilient distension (RD) by the principle of electrical capacitance calibrated to elevation of the skin surface in mm is introduced. Measurements in 14 patients of 51 lesions of localized scleroderma (morphoea) and regional controls revealed a characteristic rheological pattern in the sclerotic state representing structural alterations with reduced TD and H; H became temporarily increased during remission. Measurements in control regions showed significant correlations between TD and H (r=0.382), and between H and RD (r=0.420). Regional differences between extremities, abdomen, and back were significant and “inversely” correlated to skin thickness as measured by ultrasound (r=0.451). The method was highly reproducible according to studies on silicone rubber membrane (SD of TD different sites, 0.023 mm; SD of H, 0.010 mm; SD of TD same sites repeated, 0.010 mm). The biological, day-to-day variation in different regions of a healthy individual was considerably higher (SD of TD, 0.048–0.087 mm), in particular with respect to H (SD, 0.122–0.277 mm). TD was very variable. Experiments on abdominal skin showed that previous mechanical stress resulted in a characteristic pattern with an increase in TD and a decrease in H. Acute edema (histamine weal) resulted in a characteristic pattern with increased TD and H. Both experiments illustrated functional aspects of skin rheology overlying the structure and explaining part of the biological variation.