弹性纤维性假黄瘤1例

<正>临床资料患者女,23岁。因颈前区泛发淡黄色斑块8年来我院就诊。患者8年前颈部出现淡黄色丘疹,逐渐增多,部分融合成斑块。无自觉症状。未经治疗。家族中无类似病史。体格检查:一般情况可,心肺未见明显异常。皮肤科情况:颈部皮纹增粗,泛发淡黄色斑块,沿皮纹分布,大小不等,边界尚清,部分呈菱形分布。表面光滑,触之柔软,似皱绸样,未     

性,事关国本

我的专业不是性学,而是科学社会主义理论。我介入性学领域的活动差不多二十年了,并且还在继续,欲罢不能。主要原因是受组织委派和自己认识到性这个问题极其重要。性,是人类生活的一个重要内容,是人类最基本的需求之一,是历史和社会发展的决定因素之一。性命,性命,没有性就没有命。人的生命从开始到结束都离不开性。人生说到底就是维持和延续生命。可以毫不夸张地说,性乃人生之本。我从自己专业的视角看性:一方面它是关于“男欢女爱”的个人私事,同时它也是事关家国、社会和人类的大事。首先,性,事关国策。计划生育作为国策与性是不可分割的。当然,如果我们仅仅从计划人口数量来认识性的问题是极不全面的。我们必须认识到,人既是生产     

Blau综合征一例北大核心CSCD

患者女,13岁。全身皮疹12年,关节肿胀6年,视力下降4年。12年前（患儿1岁时）无明显诱因下肢出现大片红斑、鳞屑,无明显不适,1～2年内逐渐累及躯干、上肢、颈部,未曾自行消退或减轻。6年前出现腕关节、膝关节肿胀,无明显疼痛,不能自行缓解,逐渐加重并出现关节畸形。4年前视力明显下降,无眼痛,无局限性视野缺损。无长期反复发热、反复腹泻、头痛头晕、意识障碍等病史。曾于多家医院就诊,未明确诊断,治疗效果不理想。患儿足月顺产,生长发育尚可,智力正常。否认家族中有类似疾病。体检：神志清楚,可正常对话。眼科检查：目光呆滞,角膜不透明,     

脂肪注射填充导致失明

患者,男,32岁。左眼失明1周就诊。1周前,患者在局麻下行前额部白体脂肪注射填充,以纠正眉间纹。患者自述在接受注射的过程中,突然感到剧烈的眼周疼痛,左眼完全失明。体格检查：患者意识正常,无失语,左眼无光感,神经系统检查无异常。左侧瞳孔放大,左眼直接对光反射消失,     

儿童大疱性类天疱疮1例

临床资料 患儿男,1岁。因双下肢水疱1月余,泛发全身23天入院。1月前,患儿无明显诱因双下肢出现蚕豆大小水疱,疱液清亮,疱壁紧张。搔抓后水疱破裂,呈鲜红糜烂面,糜烂面易干涸自愈。23天前,水疱泛发全身,以胸腹部,腹股沟,双下肢为重,口腔外阴黏膜未受累。水疱可持续存在4-5天,搔抓、摩擦后破溃,糜烂面易结痂愈合,留淡褐色色素沉着,无瘢痕。皮疹反复发作,部分自愈,新水疱好发于陈旧皮损周围,呈花环状、线状排列。     

浅表皮肤脂肪瘤痣1例

患者女,16岁。右臀部起黄白色结节约10年,于2005年2月3日来我院就诊。患者10年前开始右臀部臀沟旁起淡黄色较软的结节,逐渐增大,数目逐渐增多,大小不等,向右侧发展。一般无自觉症状,受到挤压时较大结节有不适感,夏天出汗如不及时清洗有异味。1周前一较大的结节出现疼痛,3d后因化脓给予切开引流,疼痛减轻。患者系第1胎足月顺产,有一妹一弟,均无类似症状。父母非近亲结婚。体格检查:发育正常,营养中等,智力正常。右臀部可见数十个大小不等的黄白色结节,圆形或类圆形,突出于皮面,约占右臀部3/4的面积。上缘及右侧缘为新发皮损。上缘皮损呈带状,…     

磺胺药致药疹误诊为性病1例报告

1病例简介患者,男,28岁,县实验中学教师。既往体健,很少服药和输液,自己对药物过敏史不详。因患扁桃体肿大服用复方新诺明,2片/次,2次/天,第二天出现龟头红肿,包皮有两处直径约1cm的暗红色斑疹,冠状沟有一处锥形溃疡,界限清楚,有痒感。第三天龟头红肿加剧,出现两个直径约2cm的水疱,内容物微浑,冠状沟处的锥形溃疡面有脓性分泌物,尿道口少许粘性分泌物。就诊于当地医院和私营门诊,拟诊:淋病,软下疳。给予抗淋病治疗无效而转诊我院。追问病史,患者否认有不洁性生活史和婚外性行为。取尿道分泌物及水疱内容物涂片,均未找到Gˉ双球菌。考虑患者…     

瘤型麻风误诊1例

患者女,53岁。躯干、四肢丘疹、结节进行性增多2年,瘙痒1年就诊。2年前患者背、臀部出现数个黄豆大丘疹,黄褐色,逐渐长大并在丘疹部位出现烫伤样水疱,可结痂自愈。患者自觉面部浮肿,不伴自觉症状。1年前,双下肢出现黄豆至拇指头大丘疹、结节,部分结节中央溃烂,结痂。患者自觉面部、躯干瘙痒,以面部明显,经常搔抓,眉毛被摩擦脱落。曾在多家医院诊断为“神经性皮炎、结节性痒疹”,治疗无效。患者无神经麻木,四肢未见畸形。     

Rowell综合征1例

临床资料患者女,30岁。因双手出现皮疹,稍痒,渐增多,扩大,就诊我院门诊。查ANA（＋）,滴度1：320,抗SSA抗体弱（＋）,未予治疗。转诊杭州某医院,考虑红斑狼疮（LE）,予白芍总苷口服,艾洛松和布特外用,患者自行仅外用艾洛松和布特,皮疹渐消退。     

色素失禁症1例

临床资料患儿女,5岁。因头皮红斑、片状脱发,全身褐色斑疹5年,无自觉症状来诊。患儿自生后约1周左右,全身发生荨麻疹样、水疱性疣状炎性损害。无发热,一般情况尚好,无易惊,抽搐等。曾在外院诊为“湿疹”给予外用药湿敷(具体不详),上述皮损略减轻,继之出现点片及线状褐色斑疹及色素沉着斑,渐增多又来我院诊治。患儿系第1胎1产,足月顺产,母乳喂养。家系中否认有类似疾病,无肝炎、结核等传染病接触史。父母身体健康。体检:患儿发育正常,营养中等,精神、智力尚好。浅表淋巴结无肿大。左眼轻度斜视。心、肺、腹无异常,肝脾不大。皮肤科情况:头皮…     

Consensus Update for Systemic Treatment of Atopic Dermatitis

BackgroundIn 2015, the Korean Atopic Dermatitis Association (KADA) working group published consensus guidelines for treating atopic dermatitis (AD).ObjectiveWe aimed to provide updated consensus recommendations for systemic treatment of AD in South Korea based on recent evidence and experience.MethodsWe compiled a database of references from relevant systematic reviews and guidelines on the systemic management of AD. Evidence for each statement was graded and classified based on thestrength of the recommendation. Forty-two council members from the KADA participated in three rounds of voting to establish a consensus on expert recommendations.ResultsWe do not recommend long-term treatment with systemic steroids forpatients with moderate-to-severe AD due to the risk of adverse effects. We recommend treatment with cyclosporine or dupilumab and selective treatment with methotrexate or azathioprine for patients with moderate-to-severe AD. We suggest treatment with antihistamines as an option for alleviating clinical symptoms of AD. We recommend selective treatment with narrowband ultraviolet B for patients with chronic moderate-to-severe AD. We do not recommend treatment with oral antibiotics for patients with moderate-to-severe AD but who have no signs of infection. We did not reach a consensus on recommendations for treatment with allergen-specific immunotherapy, probiotics, evening primrose oil, orvitamin D for patients with moderate-to-severe AD. We also recommend educational interventions and counselling for patients with AD and caregivers to improve the treatment success rate.ConclusionWe look forward to implementing a new and updated consensus of systemic therapy in controlling patients with moderate-to-severe AD.     

抗BP180NC16A IgG亚型检测方法的建立以及在大疱性类天疱疮中的意义

【摘要】 目的 建立抗BP180NC16A IgG亚型的检测方法,并探讨其在大疱性类天疱疮（BP）中的意义。方法 原核表达GST-NC16A融合蛋白,并采用亲和层析法纯化。优化ELISA关键环节,建立抗BP180NC16A IgG各亚型的ELISA检测方法,并对10例未经治疗的BP、5例妊娠疱疹、1例成人线状IgA大疱性皮病、2例天疱疮患者血清分别进行检测。结果 通过方阵测定法确定GST-NC16A融合蛋白的包被浓度为500 μg/L,包被条件为4 ℃ 12 h,血清稀释倍数为1 ∶ 100,酶标二抗为1 ∶ 2000,孵育条件为37 ℃ 1 h,底物反应条件37 ℃ 20 min。10例大疱性类天疱疮患者10例IgG1阳性,9例IgG2阳性,5例IgG3阳性,9例IgG4阳性。2例寻常型天疱疮、1例成人线状IgA大疱性皮病均阴性。5例妊娠疱疹所有亚型均阳性,以IgG1和IgG3亚型为主。结论 抗BP180NC16A ELISA检测法特异性强、重复性好,是检测BP和妊娠疱疹患者抗BP180NC16A抗体亚型的半定量方法。     

Automated diagnostic instruments for cutaneous melanoma

The objective of this review is to report and discuss the evidence for fully automated diagnostic instruments for cutaneous melanoma tested in a real-world clinical setting directly compared with human diagnosis. A systematic review was performed and articles excluded when studies did not report sensitivity or specificity for melanoma directly compared with humans on an independent test set. Only 3 instruments have had their diagnostic accuracy compared with a human diagnosis in the clinical field with a meaningful sample size that could allow some generalization with the wider clinical arena. Two of these instruments showed a significantly inferior specificity for the diagnosis of melanoma compared with specialists. In one of these studies, the sensitivity for diagnosis, although superior to the specialist diagnosis, did not reach statistical significance. In contrast, one instrument had an equivalent specificity and trended superior but not significantly for sensitivity for the diagnosis of melanoma. Other image based nonclinic studies and studies comparing clinical management as the endpoint rather than diagnosis are also reviewed.     

Long-term results in patients with onychomycosis treated with terbinafine or itraconazole

BACKGROUND: Previously, a double-blind, randomized, multicentre study (LION study) compared the efficacy of continuous terbinafine 250 mg daily for 3 or 4 months with itraconazole pulse therapy 400 mg daily for 3 or 4 months. At the end of the study at week 72 terbinafine proved to be more effective. OBJECTIVES: To perform a 4-year follow-up of the Finnish participants in this study. METHODS: Patients were re-examined clinically and mycologically. RESULTS: Complete clinical and mycological cure with terbinafine for 4 months was 78% compared with 35% with terbinafine for 3 months, 24% with itraconazole for 4 months and 28% with itraconazole for 3 months. CONCLUSIONS: These results suggest that the initial treatment for onychomycosis should be a 4-month continuous course of terbinafine.     

黑龙江省学校性教育的困境分析与推行策略

积极推行学校性教育对于成长中的青少年极为重要,探讨可行的开展模式和实施机制是学校性教育能够有效进行的重要内容。本文对黑龙江省各级试点学校的性教育开展情况进行了现状分析,指出学校性教育实施需要教育行政部门的支持,有相应的具体工作方案,并由具体部门落实,与基层学校紧密联系,形成“行政有支持,工作有计划,多方有合作,业务有指导,培训有持续”的工作方式。惟有这样,学校的性教育工作才能循序渐进,成果可待。     

Treatment of nail psoriasis with adalimumab: an open label unblinded study

Background Despite numerous advances in the therapeutic management of cutaneous psoriasis, there is a lack of standardized therapeutic regimens for psoriatic nail disease. Objective An open, non‐randomized, unblinded study was designed to evaluate the efficacy and safety of adalimumab in the treatment of nail psoriasis. Patients/methods Seven patients suffering from severe plaque‐type psoriasis and 14 with psoriatic arthritis and cutaneous psoriasis with concomitant nail involvement were enrolled into the study. The applied dose regimen of adalimumab was the same as the one recommended for cutaneous psoriasis. Outcome measures were assessed at baseline and at weeks 12 and 24 using the Nail Psoriasis Severity Index (NAPSI). Patients also filled in a Greek translation of the international onychomycosis‐specific questionnaire to assess the impact of the nail improvement on their quality of life. Results All 21 patients completed the study and were eligible for statistical analysis. Significant improvement was recorded after the eighth injection. Mean NAPSI (NAPSIm) at baseline was 10.57 ± 1.21 for the fingernails and 14.57 ± 2.50 for the toenails in patients with just cutaneous psoriasis and 23.86 ± 2.00 for the fingernails and 29.29 ± 2.87 for the toenails in patients with psoriatic arthritis. NAPSIm at week 12 was 5.57 ± 0.78 for the fingernails and 9.57 ± 2.17 for the toenails in patients with just cutaneous psoriasis and 12.86 ± 1.05 for the fingernails and 19.21 ± 2.07 for the toenails in patients with psoriatic arthritis. NAPSIm after 24 weeks of treatment was 1.57 ± 0.20 for the fingernails and 4.14 ± 1.58 for the toenails in patients with cutaneous psoriasis and 3.23 ± 0.32 for the figernails and 10.00 ± 1.40 for the toenails in patients with psoriatic arthritis. Treatment was well tolerated with minimal and temporary side‐effects limited to the site of injection. All patients were satisfied, while marked improvement in their quality of life was recorded based on the reduction of the scores obtained from the international quality of life questionnaire. Conclusions Despite the lack of a control group, our results demonstrate a beneficial effect of adalimumab on psoriatic nail disease.     

单侧线状型汗孔角化症一例

患者,男,31岁。左侧腰腹部丘疹、斑块31年,破溃、结痂1年。既往以“银屑病”治疗多年效果欠佳,行组织病理学确诊为线状型汗孔角化症。给予阿维A 40mg/d治疗2个月效果欠佳。     

颊部滑行瓣一期修复唇缺损

目的探讨应用颊部滑行瓣修复唇缺损的方法。方法对于唇缺损1/3者采用单侧颊部滑行瓣或带黏膜瓣的鼻唇沟瓣修复;对于唇缺损1/2者采用双侧颊部滑行瓣修复;对于全下唇缺损者则采用双侧颊部滑行瓣加延长颊黏膜瓣修复。结果本组13例患者术后伤口均一期愈合,唇外形及功能恢复满意。结论应用颊部滑行瓣修复唇缺损,操作较简便。术后唇的外形和功能的恢复较远位皮瓣或皮管修复好,尤其适用于中老年唇缺损患者。     

Morphoea is neither associated with features of Borrelia burgdorferi infection, nor is this agent detectable in lesional skin by polymerase chain reaction

BACKGROUND: The aetiology of morphoea is still unknown. Borrelia burgdorferi as a causative agent of morphoea has been discussed since 1985, but the relationship remains uncertain. OBJECTIVES: We aimed to find evidence for infection with B. burgdorferi by combined evaluation of different clinical and laboratory data in a group of 54 patients with morphoea. METHODS: In each patient, an evaluation of the case history was performed with regard to infection with B. burgdorferi, using a standardized questionnaire. Questions focused on previous tick bites and skin changes suspicious for erythema migrans (EM). The case history data of 52 patients were compared with those of 104 matched control subjects and of 25 patients with acrodermatitis chronica atrophicans (ACA). Serological examinations were performed in 53 patients with morphoea. Furthermore, lesional skin was examined for borrelial DNA in 33 patients, using nested polymerase chain reaction (PCR) for the ospA and the borrelial rRNA gene. RESULTS: Results of the questionnaire showed no differences between patients with morphoea and matched controls. In contrast, patients with ACA showed a much higher prevalence of tick bites and skin changes suspicious for EM as compared with patients with morphoea. Serological examination was positive in only one patient with morphoea alone and in two additional patients with coexistent ACA. No borrelial DNA was detected by PCR in lesional skin of 33 patients with morphoea. CONCLUSIONS: No evidence was found for B. burgdorferi infection in patients with morphoea.     

Congenital melanocytic nevus with features of hybrid schwannoma/perineurioma

Neural differentiation by melanocytic nevi represents a well‐recognized phenomenon, and melanocytic nevi with perineurial differentiation have been reported recently. We reported a case of a congenital melanocytic nevus with histopathologic features of hybrid schwannoma/perineurioma. The patient was a 36‐year‐old male who presented with a black tumor on his arm since birth. Histopathology showed a congenital melanocytic nevus in the superficial dermis, but more strikingly, in continuity with the melanocytic nevus, there was a well‐circumscribed but unencapsulated nodule in the deep dermis. The nodule was composed of cellular and myxoid areas with storiform, laminated or whorled growth patterns. The cellular area was mainly composed of proliferation of plump spindle, oval or epithelioid cells. The myxoid area was mainly composed of proliferation of slender spindle cells with mucin deposition. Immunohistochemical stains showed that the cellular area was positive for S100 and CD34, weakly positive for EMA, negative for Glut‐1 and collagen IV, the myxoid area was positive for S100, negative for CD34, strongly positive for EMA and focally positive for Glut‐1 and collagen IV. Our results show that congenital melanocytic nevi may show neural differentiation with histopathologic features of hybrid schwannoma/perineurioma.