44例重症药疹患者临床分析

目的:探讨重症药疹的临床特征,分析常见致敏药物、治疗方案及转归。方法:回顾性分析2010年1月—2017年9月在我院住院治疗的44例重症药疹患者的临床资料。结果:44例重症药疹中重症多形红斑型31例,红皮病型9例,大疱性表皮坏死松解型4例。致敏药物主要是解热镇痛类、抗癫痫及抗生素类药物,全部患者均使用糖皮质激素治疗,部分使用静脉注射用人免疫球蛋白(IVIG),患者全部治愈。结论:重症药疹患者应及早足量使用糖皮质激素,必要时联用IVIG治疗,同时加强支持疗法及护理,可最大程度降低死亡率。     

儿童皮肌炎28例临床分析

目的：根据28例儿童皮肌炎的临床治疗及转归，探讨儿童皮肌炎的诊断和治疗方法。方法：回顾性分析28例儿童皮肌炎患儿的一般资料、临床表现、实验室检查、治疗及转归。结果：28例儿童皮肌炎患儿均有皮肤损害和肌酶升高，24例患儿有程度不同的肌肉症状。28例患儿均采用糖皮质激素治疗，23例患儿联合应用大剂量静脉注射用人免疫球蛋白治疗。除1例患儿因病情危重转入儿科医院治疗外，其余27例患儿均病情稳定后出院，出院后仍使用糖皮质激素维持治疗。结论：糖皮质激素目前仍是治疗儿童皮肌炎的首选药物，同时联合应用大剂量静脉注射用人免疫球蛋白治疗，可以减少糖皮质激素的用量，能够短期内控制肌肉症状、改善皮损、减少复发。     

113例药疹住院患者回顾性分析

对我院皮肤科113例药疹住院患者资料进行回顾性分析,其中92例(81.4％)可明确为一种药物致敏,抗生素类药物35例(31.0％),解热镇痛类18例(16.1％),中成药17例(15.0％),抗癫痫类15例(13.1％).轻中症药疹70例,主要表现为荨麻疹型25例、发疹型23例、多形红斑型药疹18例,给予抗组胺药、酌情应用糖皮质激素治疗均痊愈.重症药疹43例,包括红皮病型药疹11例、重症多形红斑型药疹21例、中毒性表皮松解型药疹11例,均给予大剂量糖皮质激素,部分联合静脉注射用免疫球蛋白治疗、环孢素A治疗、血浆置换治疗及血液透析治疗,38例治愈,5例死亡.     

抗菌药物致药疹住院患者35例临床分析

目的分析抗菌药物致药疹的临床表现和治疗方法。方法对我院2010年—2014年35例抗菌药致药疹住院患者资料进行回顾性分析。结果β内酰胺类药物致敏25例。非重症药疹27例,主要表现为荨麻疹型10例,麻疹型9例,多形红斑型药疹7例。给予抗组胺药或适量糖皮质激素治疗均痊愈。重症药疹8例,包括3例红皮病型药疹、3例中毒性表皮松解型药疹、2例重症多形红斑型药疹,均给予大剂量糖皮质激素,部分联合静脉注射用免疫球蛋白治疗,6例治愈,2例死亡。结论抗菌药物引起药疹临床并不少见,β内酰胺类所占比例最大,药疹临床表现多种多样,以荨麻疹型、麻疹型等非重症药疹常见,亦可出现红皮病型、中毒性表皮松解型、重症多形红斑型重症药疹,严重者导致内脏系统损伤。     

连续性血液净化联合免疫球蛋白救治20例重症药疹患者的临床分析

目的:探讨连续性血液净化联合免疫球蛋白对重症药疹的治疗效果。方法:回顾性分析2014年1月—2016年12月ICU收治的20例不能耐受糖皮质激素和或糖皮质激素不能控制病情的重症药疹患者,给予连续性血液净化联合免疫球蛋白治疗,观察患者皮损、血常规、肝肾功能转归情况及临床疗效。结果:所有20例患者除1例因患者家庭经济原因,皮损开始好转后即自动出院外,其余均转入皮肤科普通病房或痊愈出院。皮损开始好转时间为(7.56±1.93)d;联合治疗后,所有患者的血常规及肝肾功能均有改善。联合治疗后最大糖皮质激素用量明显低于治疗前最大糖皮质激素用量(P0.05),差异有统计学意义;3例患者在血液净化治疗过程中出现血小板下降,治疗结束均恢复。结论:早期连续性血液净化联合静脉注射用人免疫球蛋白可降低重症药疹患者糖皮质激素使用量,提高疗效。     

重症多形红斑及中毒性表皮坏死松解症治疗进展

重症多形红斑(Stevens-Johnson综合征)和中毒性表皮坏死松解症作为重症大疱性药疹的两种临床类型,其支持治疗包括尽早停用致敏药物、早期住院治疗、保护创面、预防感染及加强营养.特异性治疗包括早期给予足量糖皮质激素及静脉注射用人免疫球蛋白等.推荐在支持治疗基础上联合多种抗凋亡药物治疗,不推荐预防性使用抗生索.     

小剂量静脉注射用人免疫球蛋白治疗6例重症寻常型天疱疮的疗效观察

大剂量静脉注射用人免疫球蛋白（intravenous human γ-globulin，IVIG）治疗寻常型天疱疮（PV）圈内、外均有报道，并且对那些对糖皮质激素有依赖或抵抗的重症PV取得了较理想的疗效。笔者对6例重症PV患者采用小剂量IVIG治疗取得了比较好的效果，现报告如下。     

静脉注射用人免疫球蛋白治疗20例重症药疹并发严重皮肤感染患者疗效分析

目的:探讨重症药疹并发严重皮肤感染的合理治疗方法.方法:回顾性分析20例重症药疹并发严重皮肤感染患者的治疗情况.结果:20例患者经过糖皮质激素联合静脉注射用人免疫球蛋白、敏感抗生素抗感染、局部皮损处理、营养支持等治疗后均痊愈出院.结论:糖皮质激素联合静脉注射用人免疫球蛋白能有效治疗重症药疹,应尽早选用敏感抗生素控制皮肤感染.尤其是耐甲氧西林金黄色葡萄球菌感染的抗生素.局部皮损的处理及全身营养支持也极为重要.     

重症药疹112例分析

目的探讨重症药疹的临床特点及治疗措施。方法对本科2011年4月-2016年3月收治的112例重症药疹患者进行回顾性分析。相关数据采用SPSS19.0软件进行统计学分析。结果平均开始激素量为(1.97±2.35)mg/kg;在治疗过程中有17例(15.18%)患者糖皮质激素加量,比不加量组平均激素总量大、平均住院日长、皮损好转时间长;糖皮质激素联合大剂量静脉注射用人免疫球蛋白治疗患者23例(20.54%),与单独使用糖皮质激素治疗组相比不能减少平均起始激素量和平均激素总量、不能缩短平均住院日及降低死亡率,但似乎可缩短皮损好转时间,预后好;经治疗痊愈51例(45.54%)、好转58例(51.79%)、死亡3例(2.68%)。结论重症药疹治疗要个体化,起始糖皮质激素用量应早期足量,早期联合大剂量静脉注射用人免疫球蛋白对危重患者的治疗似乎有帮助。     

六年住院药疹患者回顾性分析

收集我院皮肤科2009年3月至2015年3月472例住院药疹患者资料进行回顾性分析,其中明确单一药物过敏者225例(47.67%),致敏药物中以抗生素类、解热镇痛类、抗癫痫类和中药为主。非重症药疹363例(76.91%),表现为发疹型145例,荨麻疹型39例,固定性药疹45例,多形红斑型51例;重症药疹109例(23.09%),其中Stevens-Johnson综合征53例,大疱性表皮坏死松解型16例,药物超敏综合征12例,红皮病型28例。95.76%药疹患者应用糖皮质激素治疗,非重症型与重症型药疹二组使用剂量有显著差异性,部分联合静脉注射用免疫球蛋白治疗。99.58%患者治愈,1例自动出院,1例死亡。     

以皮肤表现首诊的胃癌一例并发皮肤转移癌临床分析

目的统计我院皮肤科病理室皮肤转移癌患者资料,分析其临床特点,加深对皮肤转移癌的认识。方法报告1例以皮肤表现首诊的胃印戒细胞癌,并综合2011年1月—2016年1月的皮肤转移癌资料,分析患者年龄、性别、皮损形态特征和发生部位等特点,以及原发肿瘤的类型及皮肤转移癌与原发肿瘤发生时间的关系。结果共统计皮肤转移癌14例,占我科皮肤病理室组织病理切片总数0.24%(14/5 955例),其中男5例(36%),女9例(64%),平均年龄(57.46±12.02)岁;9例女患者中,原发于乳腺癌7例(77.8%),胃癌1例,未明确原发灶1例;5例男患者中,原发于肺癌3例(60.0%),食管癌1例,未明确原发灶1例。所有患者中以皮肤表现为首发症状3例,皮肤转移癌首发率21.4%(3/14);11例患者表现为浸润性红斑及红斑基础上的丘疹、结节,2例表现为头皮孤立结节,1例表现为胸腹部多发结节。14例皮损均分布于头颈部及胸腹部。3例患者的免疫组化显示为低分化腺癌,其中1例经及时化疗后皮损基本消失,随访1年已临床痊愈。结论皮肤转移癌发生率低,以皮肤表现首诊的转移癌少见。对于皮肤转移癌早发现、早诊断、早治疗可一定程度改善预后。     

104例泌尿生殖道沙眼衣原体感染的临床分析

目的：分析近四年西京医院皮肤性病门诊患者中生殖道沙眼衣原体检测阳性的感染特点及混合感染状况。方法：回顾性分析2007年11月～2011年6月确诊的104例生殖道沙眼衣原体感染者临床资料。结果：104例生殖道沙眼衣原体感染者中,男性感染者71例（68.27%）,女性感染者33例（31.73%）。单一衣原体感染39例（37.50%）,其中男性35例（89.74%）,占所有男性患者的49.30%（35/71）,女性4例（10.26%）,占所有女性患者的12.12%（4/33）。其余65例均为混合感染（62.50%）,其中男性36例（55.38%）,占所有男性患者的50.70%（36/71）,女性29例（44.62%）,占所有女性患者的87.88%（27/33）。女性的混合感染率高于男性,男、女性的混合感染率均高于单一衣原体感染率。结论：单一发生泌尿生殖道沙眼衣原体感染率不高,大多以混合感染形式存在,临床应对STI患者及其性伴做全面检查。     

Immunologic Aspects of Leprosy

Twenty seven cases of leprosy from Egypt were examined. Monocytes were found to be high in peripheral blood in lepromatous cases. The percentage of small lymphocytes in blood was increased in tuberculoid patients. The immunoglobulins were higher in all types of leprosy patients than in normal persons.     

Value of the 19S IgM FTA ABS test in the diagnosis and therapy of syphilis. Personal experiences and remarks on the method

Sera from patients with syphilis in various stages (525 sera specimens from untreated and 496 from treated patients) were tested, as were 17 sera specimens from infants with suspected neonatal syphilis. The tests employed for the detection of treponemal and reaginic antibodies were IgG-FTA-ABS, IgM-FTA-ABS, 19S-IgM-FTA-ABS, TPHA, VDRL and the complement fixation test. The purpose of this study was to see whether in all cases the demonstration of antitreponemal antibodies of the IgM class is a reliable criterion for treatment of seropositive patients. This was shown to be valid in nearly all cases where specific IgM was demonstrated by the 19S-IgM-FTA-ABS test. Possible biological or technical factors leading to erroneous results of this test are discussed.     

成人面部难辨认癣12例临床分析

回顾性分析我科自2013年1月至2019年6月成人面部难辨认癣患者的临床特点,共分析12例成人难辨认癣,其中男10例,女2例,年龄34~73岁,平均60.5岁,病程6~42个月,平均16.2个月。发病前均外用糖皮质激素类软膏。皮损表现:6例为湿疹样,3例为银屑病样,2例为脂溢性皮炎样,1例为玫瑰痤疮样。12例患者皮损真菌镜检均为阳性,7例真菌培养中4例为须癣毛癣菌,1例为红色毛癣菌。12例均合并足癣,2例合并股癣。     

A retrospective review of 20 hypertensive leg ulcers treated with mesh skin grafts

BACKGROUND: Few articles have been published about hypertensive leg ulcers and their surgical treatment. Since mid of the year 2000, it has been our policy to treat all hypertensive leg ulcers very early with mesh split-thickness skin grafts. The present series consists of 15 patients whose hypertensive leg ulcers, including five bilateral cases, were treated with 20 mesh grafts from 2000 to 2002. SUBJECTS AND METHODS: All patients, nine women and six men, had a long history of hypertension. The same surgical procedure was applied to all 15 patients: a complete mechanical debridement of all necrotic tissues, immediately followed by mesh skin grafting. RESULTS: Patients were discharged from the hospital after an average post-operative period of 16 days. Upon leaving the hospital, the patients had lesions completely healed in 14 of 20 cases. The graft take had been complete after an average period of 14 days. In six cases, one or two very small patches of skin graft had necrosed and complete healing required an additional period of 1 to 3 months. In all 20 cases, pain had disappeared within 1 week from surgery. DISCUSSION: All patients were on opioid therapy before surgery. With medical treatment only, hypertensive leg ulcers used to heal after a mean period of 15 months. After surgery, the average healing period was 2 weeks and opioids were stopped within 1 month after surgery. CONCLUSION: The review of the present series shows that early mesh grafting of hypertensive leg ulcers is beneficial, because healing is very quick and the pain will disappear quasi-instantly.     

7 cases of hydrofluoric acid burn in which calcium gluconate was effective for relief of severe pain

We report 7 cases of chemical burns due to hydrofluoric acid (HF). The patients suffered from severe pain. However, the pain was relieved after treatment with calcium gluconate. 6 out of the 7 cases were men. At the accidental exposures, all the patients had been engaged in washing or cleaning work and received burns on their hands and/or fingers. In one case, the forearm was also involved. During such work, all the patients had used rubber gloves, but the gloves had pinholes. For the treatments, 4% calcium gluconate jelly was applied in 5 cases and 4 of 7 were subcutaneously injected with 8.5% calcium gluconate. The involved nails were removed in 5 cases. It is concluded that physicians should provide calcium gluconate jelly and subcutaneous injections to treat an HF burn and should not hesitate to remove the involved nails. To prevent chemical burn due to HF, education and reeducation of workers regarding the hazard of this chemical are necessary.     

血管球瘤15例临床病理分析

对15例血管球瘤患者进行回顾性分析,皮损均表现为皮下红蓝色小结节,其中甲下5例,指腹2例,上肢3例,大腿内侧2例,肩部1例,腰部1例,膝外侧1例。15例患者均出现不同程度疼痛,其中5例甲下皮损对冷刺激更敏感。15例患者皮损组织病理分为四种类型,其中经典型2例,黏液型4例,球血管瘤型8例,球血管肌瘤型1例。免疫组化示15例肿瘤细胞SMA、CD34 均阳性。15例均予手术治疗,术后随访3个月,均未诉肿块及疼痛复发。     

Detection of human papillomavirus in nongenital Bowen's disease by in situ DNA hybridization

Genital Bowen's disease has been strongly linked in recent studies to human papillomavirus (HPV). Nongenital Bowen's disease has been less well investigated, although isolated reports, all of which involved detection of HPV after extraction of DNA from fresh-frozen tissue, have been made. We investigated 25 cases of nongenital Bowen's disease in 5 black and 20 white patients for the presence of HPV types 1, 6, 11, 16, and 18 using paraffin-embedded tissues. Human papillomavirus was present in six specimens from 3 of the 5 black patients (one previously reported to be positive on Southern blot) and 3 of the 20 white patients; HPV 16 was detected in all 6 cases on low-stringency testing, but only 4 remained positive on high-stringency testing. This suggests an HPV closely related to but not entirely homologous with HPV 16 in the 2 remaining cases. Five of the 6 positive specimens were lesions from the hands and feet and 1 was from the volar aspect of the arm. Clinical factors associated with the presence of HPV included black race, location on the palmar surface and the feet, young age, and verrucous or hyperkeratotic clinical appearance. Of the 6 positive cases, all 5 of the patients available for examination also had evidence of HPV-associated genital lesions. No specific histopathologic features were found to be indicative of the presence or absence of HPV.