The use of ondansetron to treat pruritus associated with intrathecal morphine in two paediatric patients

Intrathecal morphine is an effective technique for providing postoperative analgesia after major surgical procedures in children. Pruritus is a common side effect associated with intrathecal morphine. We report two patients who experienced significant pruritus associated with intrathecal morphine administration and were successfully treated with ondansetron. Ondansetron appears to be a beneficial and safe method of relieving pruritus associated with intrathecal morphine.     

妊娠期肝内胆汁郁积症综合文献335例临床分析

本文收集我国1964～1984年335例ICP临床资料,近二年占80％,多发地区在长江流域。临床特点是在妊娠晚期以搔痒和黄疸为特征。实验室检查:阻塞性黄疸。肝活检示肝内胆汁郁积。胆酸增高有助于本病的早期诊断。本症误诊率为11.6％。病因尚不清楚,可能与孕期血浆中雌、孕激素过高,或与遗传因素有关。对母儿有一定的不良影响,围产期病死率85％,防治目的是降低围产期病死率。     

三种方法治疗肛门瘙痒症的疗效对比分析

为比较不同方法治疗肛门瘙痒症的疗效及复发情况,将225例肛门瘙痒症患者随机分为3组,分别采用复方地塞米松软膏外涂（A组）、长效麻醉剂封闭加马应龙麝香痔疮膏外敷（B组）和长效麻醉刺封闭加肛周皮下神经“#”状切断术加马应龙麝香痔疮膏外敷（C组）治疗。结果显示,治疗2周后,A组总显效率为50．7％（38／75）,B组总显效率为96．0％（72／75）,C组总显效率为98．7％（74／75）。B、C组总显效率明显高于A组,P〈0．01;但B组与C组总显效率差异无统计学意义,P〉0．05。6个月后随访,A组复发41例（54．7％）,B组复发14例（18．7％）,C组复发4例（5．3％）。C组复发率最低,B组次之,A组最高,各组间差异均有统计学意义,P〈O．05。结果表明,长效麻醉剂封闭加肛周皮下神经“#”状切断术加马应龙麝香痔疮膏外敷治疗肛门瘙痒症疗效肯定,且复发率低。在常规保守治疗、封闭疗法尤效的情况下,可行肛周皮下神经“#”状切断。     

复方亚甲蓝浸润注射结合电刀网眼状点刺治疗肛门瘙痒症

为观察采用改良的复方亚甲蓝行肛周皮下浸润注射结合针状电刀网眼状点刺治疗肛门瘙痒症的效果,采用0．9％生理盐水10ml、0．75％布比卡因5ml、2％利多卡因5ml、1％亚甲蓝2ml和肾上腺素2～3滴混合均匀,用细针头在肛周皮损区做皮内皮下浸润注射,然后用针状电刀于病灶区行网眼状点刺,刺点间距约0．3cm,共治疗328例。结果显示,治愈298例（90．9％）,好转26例（7．9％）,无效4例（1．2％）,总有效率达98．8％。结果表明,亚甲蓝与布比卡因、利多卡因作用互补,暂时阻断病灶区瘙痒对神经中枢的恶性刺激,可使原来陷于病理状态的神经机能得以恢复,从而达到长期止痒的目的。     

苦参洗剂配合肤痔清软膏治疗肛门瘙痒症

目的：探讨肛门瘙痒症简单而有效的治疗方法。方法：将200例肛门瘙痒症患者分为两组,治疗组100例采用苦参洗剂坐浴配合肤痔清软膏外用,对照组100例采用高锰酸钾溶液坐浴。结果：治疗组总有效率明显优于对照组（P〈0.01）。结论：苦参洗剂配合肤痔清软膏是较为简单而有效的治疗肛门瘙痒症的方法。     

New compounds for the treatment of eczematous skin diseases

Eczematous skin diseases such as atopic dermatitis and allergic contact dermatitis are common and are characterised by the appearance of oozing, erythema, crusting, papules and, in long standing lesions, lichenification. After the successful introduction of the topical immunomodulators as a new topical therapy of atopic eczema, several other therapeutic compounds have been developed in the last 2 years. These are presented in this article based on recent patents. Primarily, developments for the treatment of pruritus and inflammation are molecules affecting the H4-receptor, the cannabinoid receptors and the prostanoid receptors, but antagonists targeting PDE4, CCR-1 or -3, or chemoattractants have also been developed. The latest patents on glucocorticosteroids and their compositions are discussed, also, the antibody-derived and cytokine-targeted therapeutical agents. In the latter case, however, the number of patents has decreased due to their time-consuming and cost-intensive production. Furthermore, one interesting patent deals with improvement of the skin barrier function and enhancement of epidermal cohesion through stratum corneum acidification. Finally, new photosensitisers or pro-photosensitisers for photodynamic therapy to treat T-cell-mediated skin disorders have been claimed. However, most of the discussed developments will need application of clinical efficacy and safety in the near future.     

Medical treatment of pruritus

Introduction: The symptom of chronic pruritus (> 6 weeks of duration) represents a worldwide burden in patients. It is described as the most frequent symptom of the skin complaints and occurs in a broad variety of diseases. However, research on pruritus has been disregarded for a long time, most likely because pruritus used to be considered as a subtype of pain.

Areas covered: Although understanding of the epidemiology, clinic and neurobiology of acute and chronic pruritus has considerably expanded in the past years, the therapy of chronic pruritus patients remains challenging. The current guidelines suggest antihistamines, pain modulators, opioid receptor antagonist and antidepressants. Using this, a large number of patients experience relief but mostly no complete resolution. Recent experiences with neurokinin receptor 1 antagonists suggest that target-specific antipruritic drugs are of high efficacy and desirable in chronic pruritus treatments.

Expert opinion: New substances and classes of antipruritic drugs are highly needed. Promising candidates are next to neurokinin receptor 1 antagonists, antagonists against the histamine 4 receptor, nerve growth factor receptor or gastrin-releasing peptide receptor.     

中药外洗、拔罐联合西药治疗慢性胆汁淤积性肝病皮肤瘙痒随机平行对照研究

[目的]观察中药外洗、拔罐联合西药治疗慢性胆汁淤积性肝病皮肤瘙痒疗效。[方法]使用随机平行对照方法,将86例门诊及住院患者按住院病志号法简单随机分为两组。两组均复方甘草酸苷,60m L/次,1次/d;还原型谷胱甘肽,1片/d,1次/d;熊去氧胆酸,1粒/次,3次/d。对照组43例炉甘石洗剂外敷(10°~15°)足底、双下肢、手掌、前臂,30min/次,1次/d。治疗组43例中药外洗(茵陈200g,苦参400g,黄柏200g,川楝子100g,赤芍300g,白鲜皮200g),以水浸泡30min,加热煮沸,再以小火煎煮20min,得到2000m L药液,以毛巾蘸取药液擦洗瘙痒部位(足底、双下肢、手掌、前臂),每次擦洗20~25min,3次/d;拔罐,取脾腧穴、胆俞穴、肝腧穴,留罐5min,以皮肤轻度充血为度,瘙痒部位闪罐治疗5min;西药治疗同对照组。连续治疗14d为1疗程。观测临床症状、皮肤损伤(程度、面积、瘙痒)、恢复时间、不良反应。治疗1疗程,判定疗效。[结果]治疗组痊愈7例,显效13例,有效19例,无效4例,总有效率90.70%。对照组痊愈2例,显效21例,有效10例,无效10例,总有效率76.74%。治疗组疗效优于对照组(P0.05)。皮肤损伤(程度、面积、瘙痒)、恢复时间(皮损好转、止痒起效)治疗组优于对照组(P0.05)。[结论]中药外洗、拔罐联合西药治疗慢性胆汁淤积性肝病皮肤瘙痒效果显著,值得推广。     

Chronic Kidney Disease-Associated Pruritus

Pruritus is a distressing condition associated with end-stage renal disease (ESRD), advanced chronic kidney disease (CKD), as well as maintenance dialysis and adversely affects the quality of life (QOL) of these patients. It has been reported to range from 20% to as high as 90%. The mechanism of CKD-associated pruritus (CKD-aP) has not been clearly identified, and many theories have been proposed to explain it. Many risk factors have been found to be associated with CKD-aP. The pruritus in CKD presents with diverse clinical features, and there are no set features to diagnose it.The patients with CKD-aP are mainly treated by nephrologists, primary care doctors, and dermatologists. Many treatments have been tried but nothing has been effective. The search of literature included peer-reviewed articles, including clinical trials and scientific reviews. Literature was identified through March 2021, and references of respective articles and only articles published in the English language were included.