睾丸生殖细胞肿瘤患者行睾丸部分切除术的1、3、5年生存率分析

目的：分析睾丸生殖细胞肿瘤患者行睾丸部分切除术后的1、3、5年生存率。方法：运用回顾性分析的方法 1998年10月至2008年10月110例来我院行睾丸部分切除术的睾丸生殖细胞肿瘤患者的临床资料,分析不同病理类型、术后行不同辅助治疗方式患者的1、3、5年生存率。结果：本研究中110例睾丸生殖细胞肿瘤患者行部分切除术后1年生存率为99.8%,3年生存率为92.8%,5年生存率为87.8%。睾丸精原细胞瘤患者的1年、3年、5年生存率分别为100%、96.6%、86.5%;睾丸非精原细胞瘤患者的1年、3年、5年生存率分别为98.7%、92.3%、80.2%,不同病理类型患者的1年、3年、5年生存率存在统计学差异（P〈0.0001）;不同病理类型的患者术后辅以不同的治疗方式1年、3年、5年生存率亦存在统计学差异（P〈0.05）。结论：睾丸生殖细胞肿瘤患者的1年、3年、5年生存率与病理类型及术后辅助治疗方式有关,睾丸精原细胞瘤患者的1年、3年、5年生存率高于睾丸非精原细胞瘤患者。     

吡柔比星联合维拉帕米膀胱灌注对膀胱癌术后复发的预防效果分析

目的:探讨吡柔比星联合维拉帕米膀胱灌注治疗应用于膀胱上皮癌术后复发的效果及安全性。方法:将本院收治的54例膀胱上皮癌行经尿道膀胱肿瘤电切术(TURBT)或膀胱部分切除术患者随机分为实验组和对照组,实验组患者给予吡柔比星联合维拉帕米膀胱灌注治疗,对照组患者给予吡柔比星膀胱灌注治疗。随访观察5年,比较两组患者1年、3年、5年的累计复发率,以及治疗过程中膀胱刺激征、血尿、化学性膀胱炎等不良反应发生率。结果:实验组1年、3年、5年的累计复发率分别为3.7%、7.4%、11.1%,不良反应发生率为51.9%;对照组1年、3年、5年的累计复发率分别为14.8%、29.6%、37.0%,不良反应发生率为48.1%。实验组3年、5年累积复发率显著低于对照组(P<0.05),不良反应发生率无显著差异(P>0.05)。结论:在吡柔比星膀胱灌注的基础上,联合应用维拉帕米能够显著降低膀胱上皮癌术后复发率并保留患者的性功能,且安全性较高,值得临床推广应用。     

播散性黄瘤合并尿崩症、高促乳素血症一例

患者女,38岁,多饮多尿16年,全身起疹12年,溢乳6年,于2007年2月5日来我科就诊。患者于1990年始无明显诱因出现烦渴、多饮、多尿（每日尿量〉4000mL）,伴间断头痛及毛发稀疏。1993年,颅部CT提示空蝶鞍综合征,血脂、空腹血糖及肝肾功能均正常。1994年,颈部、腋下、口周、眼睑、外阴及肛门依次出现大量粟粒至黄豆大黄色丘疹,无自觉症状1995年,在同济医院诊断为中枢性尿崩症,     

中国致病皮肤真菌流行病学研究-1986、1996、2006年

目的:对中国8大区1986、1996及2006年作全年临床所培养阳性的致病真菌作动态流行病学调查.方法:对全国8个大区,25 个省市,34个单位所收集的1986年、1996年及2006年全年按统一方法培养出的致病真菌进行分析.结果:1986年共分离9 096株,其中皮癣菌有7 834株;1996年共收集19 009株,其中皮癣菌有9 570株;2006年共33 022株,其中皮癣菌有12 221株,共29 725 株.在这每隔10年的调查分析显示:1986年、1996年度均以红色毛癣菌为首位菌,2006年则以念珠菌尤以白念珠菌为首位.总的趋势是皮癣菌逐渐减少而念珠菌和霉菌逐渐增多,1986年共分离计27个属、种;1996年共分出108个,而2006年则分离到117个属种病原真菌.结论:通过1986年、1996年、2006年前后21年每十年度调查全年结果,提示我国致病真菌时有变动.致病真菌均以红色毛癣菌居首,但其与念珠菌和霉菌的比率正逐渐降低,且在全国东、南、西、北、中八个大区之间亦互有变动,应引起足够重视.     

中国致病皮肤真菌流行病学研究——1986、1996、2006年

目的:对中国8大区1986、1996及2006年作全年临床所培养阳性的致病真菌作动态流行病学调查。方法:对全国8个大区2,5个省市3,4个单位所收集的1986年、1996年及2006年全年按统一方法培养出的致病真菌进行分析。结果:1986年共分离9 096株,其中皮癣菌有7 834株;1996年共收集19 009株,其中皮癣菌有9 570株;2006年共33 022株,其中皮癣菌有12 221株,共29 725株。在这每隔10年的调查分析显示:1986年1、996年度均以红色毛癣菌为首位菌,2006年则以念珠菌尤以白念珠菌为首位。总的趋势是皮癣菌逐渐减少而念珠菌和霉菌逐渐增多,1986年共分离计27个属、种;1996年共分出108个,而2006年则分离到117个属种病原真菌。结论:通过1986年1、996年、2006年前后21年每十年度调查全年结果,提示我国致病真菌时有变动。致病真菌均以红色毛癣菌居首,但其与念珠菌和霉菌的比率正逐渐降低,且在全国东、南、西、北、中八个大区之间亦互有变动,应引起足够重视。     

沉痛悼念于淞教授

哈尔滨医科大学附属第二医院于淞教授因病抢救无效,于2014年5月18日在哈尔滨医科大学附属第二医院不幸逝世,享年84岁。 于淞教授1930年9月出生,吉林桦甸人,中国共产党党员。1958年6月毕业于哈尔滨医科大学医疗系, 1962年12月到哈尔滨医科大学附属第二医院皮肤科工作,历任住院医师、主治医师、讲师、副主任医师、副教授,1982年任主任医师、教授。1962年任哈尔滨医科大学附属第二医院皮肤科主任。1984兼任哈尔滨医科大学图书馆馆长。1979年任硕士研究生导师……     

114例MB麻风6个月联合化疗后随访3年细菌指数变化

目的:评价6个月联合化疗方案治疗MB麻风细菌指数变化.方法:采用世界卫生组织多菌型方案对新发114例查菌阳性麻风患者治疗6个月,并对观察治疗前后及随访3年中每年细菌指数的变化进行了分析.结果:114例麻风疗前平均细菌指数3.01,其中分别有108、97、88、83例完成治疗和1年、2年、3年随访.1例停止治疗后13个月复发.治疗结束、1年、2年和3年随访时平均细菌指数值分别为1.82、1.01、0.63和0.39.3年随访患者完成治疗、1年、2年和3年随访时细菌阴转率分别为19.28%、27.71%、46.99%和69.88%.结论:6个月联合化疗后随访3年,细菌阴转率持续上升.由于随访时间较短,且已有复发病例报告,对6个月联合化疗方案疗效需进一步随访观察.     

北京丰台医院近5年门诊性传播疾病患者679例临床分析

目的了解北京丰台医院近五年性传播疾病的发病趋势和流行特点,为预防和控制性传播疾病提供依据。方法收集2005～2009年北京丰台医院皮肤性病科门诊就诊的性传播疾病患者的临床资料,包括梅毒、淋病、非淋菌性尿道炎(NGU)、生殖道沙眼衣原体感染、尖锐湿疣及生殖器疱疹,进行统计学分析。结果 2005～2009年北京丰台医院皮肤性病科门诊累计报告梅毒、淋病、非淋菌性尿道炎(NGU)、生殖道沙眼衣原体感染、尖锐湿疣及生殖器疱疹共679例,其中2005年发病率最高(203例),2009年最少(75例)。2005年梅毒患者仅3例,2009年梅毒患者增至18例。五年报告尖锐湿疣245例。结论 2005～2009年北京丰台医院皮肤性病科门诊性传播疾病患者数量呈逐年下降的趋势,其中2008年下降幅度略大,但梅毒病例出现增多趋势,尖锐湿疣位居发病的首位。     

保乳手术联合他莫昔芬治疗早期乳腺癌患者的疗效及对hMAM、TGF-β1水平的影响

目的分析保乳手术联合他莫昔芬治疗的临床疗效,及对患者hMAM、TGF-β1水平影响。方法选取2016年1月至2017年12月间唐山市协和医院诊治的80例乳腺癌患者作为研究对象。采用随机信封法分为观察组及对照组。对照组采用保乳手术治疗,观察组采用保乳手术联合他莫昔芬治疗;随访3年统计患者1年、2年和3年生存率、复发率及不良反应发生率;检测患者血中TGF-β1水平和hMAM水平。结果观察组患者0年～1年、1年～2年及2年～3年生存率均显著高于对照组,差异具有统计学意义(P0.05);观察组患0年～1年、1年～2年及2年～3年乳腺癌复发率均显著低于对照组,差异具有统计学意义(P0.05);治疗后两组患者hMAM、TGF-β1水平均显著低于治疗前,差异具有统计学意义(P0.05),治疗后观察组患者hMAM、TGF-β1水平均显著低于对照组,差异具有统计学意义(P0.05);治疗后观察组患者阴道流血不良反应发生率显著低于对照组,差异具有统计学意义(P0.05)。结论采用保乳手术联合他莫昔芬治疗乳腺癌后可有效提高临床疗效,并降低患者血中hMAM及TGF-β1水平。     

追思胡萍老师

胡萍(1963年2月9日-2022年11月9日),1986年毕业于重庆医科大学儿科系,曾任儿科医师和儿科学讲师。2001年开始,在小学、幼儿园等机构开展儿童性健康教育研究,迄今在全国近百座城市举办上千场性健康教育讲座。2009年开始受邀在中央电视台、新浪育儿、腾讯公益等平台录制性健康教育节目。2014年创办“善解童贞”性教育品牌,2017年起发起“善解童贞”性健康教育研讨会,已连续举办四届。著有一系列儿童性健康教育书籍,2020年担任全国妇联《儿童安全防护手册》特邀专家。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Evidence‐based skin care in preterm infants

Most guidelines on neonatal skin care emphasize issues pertaining to healthy, term infants. Few address the complex task of skin barrier maintenance in preterm, very preterm, and extremely preterm infants. Here, we provide an evidence‐based review of the literature on skin care of preterm neonates. Interestingly, the stratum corneum does not fully develop until late in the third trimester, and as such, the barrier function of preterm skin is significantly compromised. Numerous interventions are available to augment the weak skin barrier of neonates. Plastic wraps reduce the incidence of hypothermia while semipermeable and transparent adhesive dressings improve skin quality and decrease the incidence of electrolyte abnormalities. Tub bathing causes less body temperature variability than sponge bathing and can be performed as infrequently as once every four days without increasing bacterial colonization of the skin. Topical emollients, particularly sunflower seed oil, appear to reduce the incidence of skin infections in premature neonates—but only in developing countries. In developed countries, studies indicate that topical petrolatum ointment increases the risk of candidemia and coagulase‐negative Staphylococcus infection in the preterm population, perhaps by creating a milieu similar to occlusive dressings. For preterm infants with catheters, povidone‐iodine and chlorhexidine are comparably effective at preventing catheter colonization. Further studies are necessary to examine the safety and efficacy of various skin care interventions in premature infants with an emphasis placed on subclassifying the patient population. In the interim, it may be beneficial to develop guidelines based on the current body of evidence.     

Occupational allergic contact dermatitis from spices

About 1000 patients were investigated at our clinic during 1991 for occupational skin disease. and 5 had occupational allergic contact dermatitis from spices. The patients were chefs, or kitchen, coffee room, and restaurant workers. All patients had hand (or finger) dermatitis. The causative spices were: garlic, cinnamon, ginger, allspice and clove, The same patients also had allergic patch test reactions to foods: tomato, lettuce and carrot. Paprika elicited a weak allergic patch test reaction in 2 patients. Occupational allergic contact dermatitis from spices is relatively rare, but needs to be taken into consideration in patients who have hand dermatitis, and work with spices and foods, Patch testing with spices as is useful, but testing with dilutions in pet, may be needed to confirm that the patch test reactions are allergic. Patients also need to be prick tested with spices and foods.     

Subfascial endoscopic perforator vein surgery

Chronic venous insufficiency is a tremendous health care problem in western societies. Venous disease can affect any combination of the superficial, deep, and perforator venous systems of the lower extremities. Generally the superficial venous deficits are addressed through sclerotherapy, enovenous ablation, stab phlebectomy, and or stripping. Patients with advanced clinical sequelae (lipodermatosclerosis or ulceration) of CVI should also be evaluated for the presence of incompetent perforating veins. Open surgical approached to the calf perforating veins (ie. Linton procedure) were complicated by significant wound complications and have largely been replaced by the less invasive Subfascial Endoscopic Perforator Surgery (SEPS). The use of SEPS in patients with ulceration has been shown to be safe and to reduce the time that patients will have ulcers during follow-up. This chapter will review the pathophysiology, diagnosis, and treatment of incompetent perforating veins of the legs with particular attention to surgical issues.