早期梅毒63例临床分析

一、临床资料本组病例来源于1994年2月至1995年3月间我所性病专科门诊,资料记录齐全者63例,其中男52例,女11例;年龄20～64岁,平均36.1岁,<30岁24例(38%);已婚54例,未婚9例;工人24例、个体10例、司机8例、农民6例、待业青年5例、供销员5例、服务员3例、干部2例;因非婚性接触传染48例,夫妻传染10例,传染源不明5例.     

艾滋病相关型Kaposi肉瘤9例

我院自2006年5月至2007年6月共收治9例艾滋病相关型Kaposi肉瘤患者,现报道如下. 临床资料 9例艾滋病相关型Kaposi肉瘤中男7例,女2例;年龄20～43岁,平均32岁;病程2月～1年,平均半年;有吸毒史5例、异性不洁性交史1例、输血感染1例,配偶感染1例,不详1例;小学文化程度6例、中学2例、大学1例;未婚4例、已婚3例、离婚2例;8例维吾尔族、1例锡伯族;农民2例、干部1例、司机1例、无职业5例.     

派瑞松霜治疗亚急性慢性湿疹疗效观察

我们用派瑞松霜(西安杨森制药有限公司生产)治疗亚急性、慢性湿疹45例,取得较好疗效。临床资料　选择45例皮损典型患者,男30例,女15例,年龄3～72岁,平均23.3岁。病程1个月～10年。部位:手16例、四肢11例、躯干10例、足8例、面部7例、间擦部4例、臀部4例。皮损:红斑41例,丘疹32例,鳞屑32例,苔藓化23例、结痂14例、皲裂12例、渗出11例、摩烂9例、水疱7例。患者均有中度至重度瘙痒。治疗方法　将派瑞松霜涂抹患处,早晚各1次,连用3周,每周观察1次,治疗结束评定疗效。结果　疗效判定标准:痊愈为痒感消失,皮损全部消退;显效为瘙痒明显减轻,皮损消…     

皮质类固醇激素软膏外用致不良反应84例分析

<正> 一般资料84例中男51例,女33例。年龄2～60岁。发病在面部27例,躯干部15例,四肢42例。有狗猫接触史者5例。原发疾病为体癣23例、股癣30例、面癣7例、痤疮15例、面部糠疹5例、湿疹4例。外用皮质类固醇激素软膏2周以内发病者32例,半年以内者29例,半年以上者23例。外用20支以内者71例,40支以内者11例,有2例应用200支以上。外用肤轻     

液氮冷冻联合阿昔洛韦等治疗带状疱疹400例

我们于2002年8月至2010年6月,使用液氮冷冻联合阿昔洛韦、聚肌胞注射液治疗带状疱疹400例,得到较满意疗效,现报道如下.一、临床资料400例带状疱疹患者均来自我院皮肤科门诊或住院患者,具有典型的临床症状,依据赵辨《临床皮肤病学》带状疱疹诊断标准诊断,发病时间平均3d.治疗组200例,男87例,女113例,15 ～ 75岁,平均47.2岁,皮损累及颈、肩及上肢33例,胸背部74例,腰腹部40例,臀部、会阴及下肢53例,皮损为红斑、丘疱疹157例,血疱13例,脓疱26例,大疱4例.自觉患处烧灼感、疼痛剧烈166例;疼痛、痒及烧灼感轻微者34例.对照组200例,男73例,女127例,17～77岁,平均48.1岁,皮损累及颈、肩及上肢31例,胸背部70例,腰腹部35例,臀部、会阴及下肢64例,皮损为红斑、丘疱疹161例,血疱15例,脓疱22例,大疱2例.自觉患处烧灼感、痛、痒剧烈162例;疼痛、痒及烧灼感轻微者38例.     

性病

951900 89例性病调查分析/陈孟贤…//中华流行病学杂志。-1995,16(2).-65 淋病84例、尖锐湿疣4例、阴虱1例;淋病继发女盆腔炎2例、男前列腺炎2例、精囊炎1例。男性69例,女性20例,男女比例3.45:1;19～40岁年龄组51例,占57.30％,干部15例、司机15例、个体户13例,     

住院病人经会诊发现性病35例分析

1995年1月～2005年7月在我院各临床科室住院病人中经皮肤性病科会诊发现性病35例,现报道如下。临床资料本组35例性病患者中,男29例,女6例;年龄19～63岁,平均31.2岁;职业:个体业主9例、干部7例、工人及农民工各5例、农民4例、教师3例、学生2例。梅毒17例(一期梅毒3例、二期梅毒10例、早期潜伏梅毒2例、三期梅毒2例即上腭穿孔1例和心血管梅毒1例)、尖锐湿疣9例、非淋菌性尿道炎4例、淋病及生殖器疱疹各2例、阴虱1例。有非婚性接触史29例、否认性接触传染史6例。28例患者的性病损害发生在住院前。4例发生在入院后。在前者,入院当日由首诊医生为…     

贺县89例麻风病人的畸残

1953～1991年共发现403例麻风,其中男292例,女24例;有畸残89例,男女畸残分别为65例和24例,畸残率分别为22.26％和 21.62％;I 4例,TT 197例,BT 11例,BB 39例,BL 12例,LL 104例,其中畸残人数分别为0、30、2、8、1和48,畸残率(％)分别为     

皮肤平滑肌瘤117例临床病理分析

皮肤平滑肌瘤并非少见,但因其体积小,多无自觉症状,常不被医师或患者注意,因而检出率远低于发病率。现将我们诊断及会诊的 117例总结报道如下。 一、临床资料 (一 )一般资料：皮肤平滑肌瘤 117例,男 50例,女 67例,男女之比为 1∶ 1.34。年龄 4.5～ 73岁,平均 38.9岁,其中 60岁 8例。 (二 )发病部位：头面部 20例、颈部 4例、上肢 23例、下肢 40例、胸背部 7例、乳腺 6例 (其中 3例位于乳头或乳晕 )、腹壁 4例、尿道口 4例、大阴唇 6例、阴囊 2例、会阴 1例。以四肢最多见,共 63例,占 53.8％。 (三 )临床表现：患者多以皮下或…     

碘化钾治疗结节性红斑与结节性脉管炎

作者将45例下肢结节性炎性损害分为两组。(1)28例结节性红斑,病期1～8周,起因于扁桃体炎与流感者各7例,肉样瘤病4例、怀孕2例、口服避孕药2例、齿脓毒病2例、窦炎1例、原因不明2例。(注、原文如此,缺1例)(2)结节性脉管炎17例,3例可能由流感诱发,2例有窦炎、2例有慢性扁桃体炎、1例齿部感染、1例口服避孕药、8例未发现病因。用药方法为碘化钾合剂或放在胶囊中的粉剂。每日360～900毫克,疗程至少3～4周。最大日量900毫克者36例,540毫克者5例,360毫克者4例。怀孕者量宜小,怀孕最后3个月避免给药,以免抑制胎儿的甲状腺功能。5例扁桃体炎者给以短程抗菌素疗法。     

Prevention of murine erythropoietic protoporphyria-associated skin photosensitivity and liver disease by dermal and hepatic ferrochelatase

Erythropoietic protoporphyria (EPP) is caused by a defect in ferrochelatase, leading to the accumulation of protoporphyrin predominantly in erythrocytes and hepatocytes, and resulting in skin photosensitivity upon leaching of blood protoporphyrin into the skin. Some patients also develop severe liver damage. Because the respective contributions of hepatic and erythrocytic protoporphyrin to the pathophysiology of EPP remain unclear, we investigated this question using the murine model of EPP. Transplantation of bone marrow from EPP mice to normal recipients resulted in elevated erythrocyte and plasma protoporphyrin levels. However, quantification of serum liver enzymes and bilirubin together with histopathologic examination of liver sections of mice up to 16 months post-transplantation showed no evidence of liver damage. Moreover, despite massive elevation of serum protoporphyrin, transplanted mice showed minimal evidence of skin photosensitivity. Photosensitivity could also be prevented locally by implanting skin grafts from normal mice onto the backs of EPP recipients. These data validate the hypothesis that the main source of toxic protoporphyrin originates from the erythrocytes. However, we unexpectedly observed that normal ferrochelatase activity in hepatic and dermal cells of wild-type mice is sufficient to prevent liver disease and significant skin photosensitivity. These findings may provide new strategies for the treatment of EPP.     

Erythropoietic Protoporphyria: A Report of the First South Australian Case

The first case of erythropoietic protoporphyria diagnosed in South Australia is presented. The clinical picture is of the “light-sensitive lipoid proteinosis” type. The diagnosis was considered in 1965 but discarded for lack of biochemical confirmation; it was established by skin biopsy in 1968, and subsequently confirmed by finding fluorescent erythrocytes and increased faecal protoporphyrin. An unusual feature is the' late onset at age 14.     

Serum 25-hydroxyvitamin D in erythropoietic protoporphyria

Background  Vitamin D, produced by the action of sunlight on skin, is an important hormone for calcium homeostasis and has been implicated as tumour-protective agent. Some previous studies of photosensitive patients who actively avoid sunlight have failed to show convincing evidence of vitamin D insufficiency.
Objectives  The aim of this study was to characterize the vitamin D status of a large cohort of patients with erythropoietic protoporphyria (EPP).
Methods  U.K. patients with EPP were recruited prospectively and seen locally by a single study investigator. A blood sample was taken for vitamin D assay. All blood analyses were performed in the same laboratory.
Results  A cohort of 201 patients with known EPP was seen over a 7-month period between January and July. Thirty-four patients (17%) were deficient in vitamin D and 126 (63%) had insufficient vitamin D. Both insufficiency and deficiency were significantly associated with the total erythrocyte protoporphyrin concentration and inversely with the time in minutes to the onset of symptoms following sunlight exposure.
Conclusions  This is the first report of significant levels of vitamin D deficiency and insufficiency in a large cohort of patients with a photodermatosis. Such individuals are at risk of associated adverse events. In future, clinicians should consider monitoring 25-hydroxyvitamin D levels and instigating oral supplementation or dietary advice if appropriate.     

Can autofluorescence demarcate basal cell carcinoma from normal skin? A comparison with protoporphyrin IX fluorescence.

Fluorescence detection may help to demarcate skin cancer from normal skin, thus to reduce the potential of incomplete treatment resulting from unawareness of tumour extension in surrounding skin. In this study we evaluated the difference between autofluorescence of basal cell carcinomas (n = 21) and the normal-appearing skin surrounding them. Referring to the difference found, a point-by-point measurement was taken from the tumour lesions outwards to the surrounding skin to locate the differentiation point of autofluorescence on the skin. Protoporphyrin IX fluorescence was measured from the same spots using the same procedure, after the tumours and the surrounding skin had been treated with topical 5-aminolevulinic acid methyl ester cream. The point-by-point measurement enabled us to locate the vanishing point of the protoporphyrin IX peak, which was compared with the differentiation point of autofluorescence to assess the utility of autofluorescence in tumour demarcation. Illuminated by 370 nm light, both the tumour and surrounding skin emitted a fluorescence with peak intensity at 455+/-3 nm. The peak intensity was 53% (18-84%) (median, range) lower in the tumours than in normal skin (p<0.001). In 78% of the measurements, the differentiation point of the autofluorescence was within 3mm of the vanishing point of the protoporphyrin IX peak. Autofluorescence may be used in BCC demarcation.     

Skin changes in variegate porphyria

Summary The skin of 20 patients with variegate porphyria (VP) was studied using light, fluorescent, and electron microscopy. Twelve patients had skin symptoms and markedly increased fecal protoporphyrin excretion. Their sun-exposed skin was characterized by homogeneous PAS-positive thickening and IgG deposition in the vessel walls. The basic ultrastructural change was thickening of the vascular walls caused by reduplication of the basal lamina and perivascular deposition of amorphous material. Qualitatively similar but less prominent histopathological changes occurred in sun-protected skin in some of the patients. Six patients had no skin symptoms but an increased porphyrin excretion. The light microscopical changes were comparable to those in the patients with skin symptoms, but the ultrastructural changes were less severe. No abnormal histopathological changes occurred in two symptomless patients who had low lymphocyte protoporphyrinogen oxidase activity but normal fecal porphyrin excretion. These results show that the primary site of skin damage in VP is the vessel wall, and that histopathological changes of the skin also occur in porphyric patients who have never had skin symptoms. Factors determining the occurrence of skin symptoms in VP are discussed.This study is supported partially by a grant from Sigrid Juselius Foundation     

Effects of haem arginate on variegate porphyria

Four patients with variegate porphyria (VP) were treated with repeated haem arginate infusions daily for 4 days and then weekly for 4 weeks. After the initial four daily doses of haem arginate (haem 3 mg/kg), the excretion of faecal protoporphyrin (mean 579 nmol/g dry wt) fell to an almost normal level (mean 123 nmol/g dry wt), and that of coproporphyrin (mean 162 nmol/g dry wt) to the normal level (mean 21 nmol/g dry wt) in all patients. However, during the period of the four weekly infusions of haem the excretion of porphyrins increased almost to the pretreatment level. Phototesting showed no changes in the photoreactivity of the skin, and no improvement in skin lesions was seen during the treatment. Except for one case of thrombophlebitis no side-effects occurred. In a child with homozygous VP, four daily infusions of haem arginate (2 mg/kg) normalized the faecal protoporphyrin content, but had no effect on the increased erythrocyte protoporphyrin concentration.     

PpIX fluorescence kinetics and increased skin damage after intracutaneous injection of 5-aminolevulinic acid and repeated illumination

Photodynamic therapy with topically applied 5-aminolevulinic acid is used successfully for superficial skin lesions. The results for thicker, nodular lesions are less favorable. The method of aminolevulinic acid administration, the concentrations of aminolevulinic acid, and the irradiation schemes used so far have not been investigated thoroughly. As aminolevulinic acid photodynamic therapy has high potential for the increasing problem of skin cancer, we investigated both visually and histopathologically the photodynamic-therapy-induced skin damage after intracutaneous administration of aminolevulinic acid in normal porcine skin. We also investigated the kinetics of the aminolevulinic-acid-induced photosensitizer protoporphyrin IX fluorescence after irradiation in relation to fluence and irradiance. Finally we investigated the effect on photodynamic-therapy-induced damage of a fractionated irradiation. This study demonstrates that intracutaneous administration of aminolevulinic acid leads to higher fluorescence levels and thus to formation of higher protoporphyrin IX concentrations than topical application of aminolevulinic acid cream. The peak level of protoporphyrin IX after intracutaneous administration of aminolevulinic acid is reached earlier than after topical administration. The comeback of fluorescence, indicating re-synthesis of protoporphyrin IX after irradiation, is inhibited with increasing fluence. Photodynamic-therapy-induced damage increases with increasing fluence, but is independent of the irradiance. Finally, the photodynamic-therapy-induced skin damage seems to be greater after fractionated irradiations with two equal light fractions of 15 J per cm2 separated by a dark interval of 2 h.     

Morphine gel 0.3% does not relieve pain during topical photodynamic therapy: a randomized, double-blind, placebo-controlled study

There is a demand for pain relief during photodynamic therapy. We therefore investigated the efficacy and side-effects of topical morphine gel 0.3% for pain relief during topical photodynamic therapy in a randomized, double-blind, placebo-controlled study. The study involved 28 patients with actinic keratoses or basal cell carcinomas. Each patient was treated with photodynamic therapy after superficial curettage of 2 treatment areas that were randomized to morphine gel or placebo gel. The gels were applied 15 min before illumination. Pain was assessed pre-illumination, during, and immediately after illumination, using a numeric rating scale. Skin redness was determined by reflectance spectrophotometry and the size of the treated area by protoporphyrin IX fluorescence. There were no differences between the areas according to accumulation of protoporphyrin IX (p =0.34), size of fluorescence areas (p =0.84), or skin redness (p =0.95). There was no significant pain relief of topical morphine gel compared with placebo gel (p >0.23). This negative result suggests that opioid receptors may not be involved in the pain induced by photodynamic therapy.     

Prevention of photosensitivity with action spectrum adjusted protection for erythropoietic protoporphyria

Erythropoietic protoporphyria is a genetic disease characterized by sensitivity to sunlight caused by the accumulation of protoporphyrin IX. Photoprotection against ultraviolet A and visible light is necessary for erythropoietic porphyria patients because the absorption spectrum of protoporphyrin IX lies in both ultraviolet A and visible light region. We developed a novel index, in vitro porphyrin protection factor, based on the protoporphyrin IX absorbance spectrum. We also selected appropriate photoprotective products designed according to protoporphyrin IX absorbance. The porphyrin protection factors of a combination of make‐up base with a powder as well as with a liquid foundation were significantly higher than those of a conventional sunscreen product, even at a small application dose. An in‐use test carried out for 6 months showed that the efficacy of these products was 78.3%, and no adverse reactions were observed. Male subjects preferred liquid foundation, whereas all female subjects used powder foundation. The preference of the subjects could lead to the long‐term use of the tested products. In conclusion, this study provided a new approach to improve photoprotection in erythropoietic protoporphyria patients.     

Preliminary exploration of the clinical features of Chinese patients with skin malignancies and premalignancies: a retrospective study of 1420 cases from Peking University First Hospital

Background The epidemiological and clinical characterization data of skin malignancies and premalignancies in Chinese population is scarce and inadequate. Objective To systematically investigate the clinical features and the trend of skin malignancies and premalignancies in 1420 Chinese cases. Methods A total of 1398 patients (presenting 1420 skin tumours) were included. Clinical and demographic information for every individual was collected, including age, age of onset, sex, lesion location, disease duration and tumour histology, which was analyzed for each type of skin tumours. Results The number of skin malignancies and premalignancies increased over time, with Basal cell carcinoma (BCC) as the most common type (30.5%). The majority of the patients were above 60 years of age both at onset and at diagnosis (52.8% and 62.9%, respectively), yet around one‐third of patients were between 35–59 years (35.3% and 31.2%, respectively). Skin malignancies and premalignancies were mainly located in the head and neck (58.6%), followed by the trunk (18.3%) and the extremities (15.0%). Of all BCCs, nodular BCC was the most common histologic subtype (62.8%), while 15.8% were classified as aggressive subtypes. Malignant melanoma (MM) comprised the lowest proportion of 3.7%, with 75% located on extremities. The diagnostic accordance rates varied from 49.5% to 90.4%, with BCC being 67.9%. Conclusions The clinical features of skin malignancies and premalignancies in this study showed some similarities with those observed in Caucasian and other Asian populations, with several distinguished features in Chinese patients also being recognized. Closer attention to suspicious lesions in young and middle‐aged people is needed.