非典型麻疹36例

自20世纪60年代中期我国普遍推广麻疹活疫苗后,麻疹的发病率和死亡率明显下降,但非典型麻疹发病率逐渐增高,我院2000年至2004年收治的麻疹病人中有36例非典型麻疹,现分析如下。1临床资料36例中男性24例,女性12例,年龄1岁~5岁,均接种过麻疹疫苗1次,未复种。发病季节以冬末早春较多。城镇儿童10例,农村26例。发热病人,体温37.5℃~38.5℃20例,39℃8例,39.5℃6例,39.5℃以上2例。眼结膜充血流泪畏光20例,流涕打喷嚏16例。出现麻疹黏膜斑25例,皮疹:发热2d、3 d、4 d、5 d后出疹分别为15例、10例、6例、5例。皮疹稀疏淡红24例,典型皮疹12例,皮疹由…     

烂喉痧(猩红热)病史考略

烂喉痧病曾是我国近代猖獗一时的流行性传染病,夺走无数人的宝贵生命。医界人士对此病予以高度重视,从临床医家到理论研究人员从各个角度进行了深入研究,并得出一个公正的结论：即在西医有效疗法未问世之前,祖国医药曾对此病的防治做出重大的贡献。     

Expert Consensus on the Management of Erlotinib‐Associated Cutaneous Toxicity in the U.K.

Rash has been reported in up to 76% of patients with lung cancer who have received the epidermal growth factor receptor inhibitor (EGFRI) erlotinib. It has also been observed in patients treated with other agents that have a similar mode of action. Erlotinib‐associated skin toxicity typically presents as a papulopustular, follicular, acneiform rash. In most cases, it is mild, transient, and well tolerated, but in 8%–12% of patients, it may be sufficiently severe and persistent to necessitate intervention. Increasingly strong data suggest that the incidence and severity of skin toxicity may be predictive of response and survival in patients treated with erlotinib. This has prompted some clinicians to consider “treatment to rash” (i.e., increasing the dosage until a rash appears) as a rational management strategy. In 2007, an international consensus was developed for the management of EGFRI‐associated skin toxicity. Subsequently, a multidisciplinary group (the U.K. Erlotinib Skin Toxicity Management Consensus Group) met to validate and modify the international recommendations for U.K. use, with specific reference to erlotinib. Although many aspects of the international consensus were approved by the group as being relevant for the U.K., certain parts were modified. The resulting expert opinion is a practical and workable version of the international proposal that considers all applicable national issues regarding the management of erlotinib‐associated skin toxicity.     

2005—2008年玉溪市发热出疹性疾病病例监测分析

目的通过对玉溪市发热出疹性疾病病例流行病学监测分析,全面掌握玉溪市发热出疹性疾病流行规律,为制定防制措施提供科学依据。方法对玉溪市2005—2008年以来发热出疹性疾病监测情况作描述性流行病学分析。结果 2005—2008年共报告554例疑似麻疹发热出疹性疾病病例,其中实验室检出麻疹IgM抗体阳性305例、确诊率为55.05%;风疹IgM抗体阳性67例、确诊率为11.91%;未检出麻疹IgM和风疹IgM病例182例,占总病例的32.85%。结论玉溪市目前发热出疹性疾病病例以麻疹为主,各年龄段均有病例,发病主要集中在冬春季,同时具有一定数量的风疹病例,以及其他类型的出疹性疾病。     

379例发热出疹性疾病血清流行病学分析

为了解四川省发热出疹性疾病（RFIs）的血清流行病学特征,以便更好地开展麻疹监测,1997～2000年5月,在该省20个县采集了暴发和散发病例的急性期血清标本,用酶联免疫吸附试验(ELISA)捕捉法检测麻疹和风疹IgM抗体。结果379例中确诊为麻疹的192例（50.66％）,风疹80例（21.11％）,其它RFIs107例（28.23％）。379份血清标本中,麻疹IgM抗体阳性144份,阳性率37.99％;风疹IgM抗体阳性40例（10.55％）。RFIs发病高峰季节为春季,发病以＜15岁儿童为主,暴发病例以麻疹为主。血清学诊断是科学鉴别RFIs的重要手段。加强麻疹疫苗的有效接种和强化免疫,是加速控制麻疹的主要策略。     

以消化道症状首发的混合型过敏性紫癜误诊18例临床分析

目的：探讨以消化道症状为首发表现的混合型过敏性紫癜的临床特点,以减少误诊。方法：分析我院2006年1月至2012年12月收治的18例以消化道症状为首发表现的混合型过敏性紫癜患儿的临床资料,总结易致误诊的因素。结果：6例首发表现以呕吐、腹泻为主,伴有腹部不适,误诊为急性胃肠炎;10例首发表现以腹痛反复阵发性发作为主,脐周疼痛（其中3例发热,发热症状先于腹痛症状）,误诊为肠系膜淋巴结炎;2例首发表现为脐周及右下腹腹痛,误诊为急性阑尾炎。早期治疗阶段,腹痛均无缓解,4 h～7 d出现不同程度的双下肢皮疹而诊断为混合型过敏性紫癜,给予泼尼松2 mg/（kg·d）分次口服、抗生素、氯雷他定、大剂量维生素C等治疗,治疗3 d后腹痛均缓解,治疗10～15 d治愈出院。结论：临床遇到以消化道症状首发的混合型过敏性紫癜时,要时刻观察疾病的演变过程。对无皮疹表现,早期对症治疗效果不佳者,要认真分析病史资料,结合相关实验室检查（胃镜、腹部B超、血沉等）以减少误诊的发生。     

Successful treatment of refractory rash in paraneoplastic amyopathic dermatomyositis

Skin involvement in dermatomyositis does not always parallel muscle disease and can be the most active or severe component of the disease, failing to respond to therapeutic interventions that are adequate for myositis and other systemic involvement. This case refers to a resistant paraneoplastic amyopathic dermatomyositis rash which readily resolved with intravenous immunoglobulin (IVIG), practically in the form of monotherapy. This observation gains particular significance considering that IVIG is still regarded as a second-line therapeutic regimen in the treatment of dermatomyositis despite its prevalence in matters of safety.     

Predictors of Lamotrigine-associated rash

PURPOSE: To determine the predictors of lamotrigine-associated rash (LTG-rash) and the incidence of serious and benign LTG-rash to individualize risk assessment in a given patient. METHODS: We reviewed the charts of all 988 outpatients seen at the Columbia Comprehensive Epilepsy Center between January 1, 2000, and December 31, 2003, who received LTG. Charts were reviewed for documentation of rash developing from any medication, including antiepileptic drugs (AEDs) and non-AEDs, and including remote histories of drug-related rashes. Demographics, medical history, and medication variables were tested as potential predictors of LTG-rash. RESULTS: Fifty-six (5.7%) of 988 patients experienced rash attributed to LTG, and 39 (3.9%) discontinued LTG because of rash. No patients experienced toxic epidermal necrolysis or required hospitalization because of LTG-rash. One case of mild probable Stevens-Johnson syndrome occurred. In multivariate analysis, a history of rash after another AED was the strongest predictor of LTG-rash (13.9% vs. 4.6%; OR = 3.62; p < 0.001), with children younger than 13 years also experiencing significantly more LTG-rash (10.7% vs. 4.3%; OR = 2.77; p < 0.001). In children with a rash attributed to another AED, 18.2% experienced LTG-rash, whereas in adults without a rash from another AED, 3% experienced LTG-rash. CONCLUSIONS: Based on this retrospective analysis, a history of another AED-related rash is the greatest risk factor for developing rash to LTG; age younger than 13 years is also a risk factor. Severe rash is rare when using the currently recommended titration rate.