下肢血栓闭塞性脉管炎误诊一例北大核心CSCD

患者男,38岁,因右足趾反复红肿、疼痛10个月,加重伴窦道形成15d入院。10个月前,患者行足第4趾不慎划破后,有足足趾均出现红肿、疼痛,第4趾甲周脓液渗出,当地医院诊断为甲沟炎．行拔甲术及抗生素治疗后,皮损好转,但反复发作。15d前,右足第2趾甲红肿、溃烂并出现窦道,伴黄色渗液,迅速累及右足全部足趾,触碰及行走时疼痛不适,门诊以脓性趾头炎收入院。吸烟史10年余,每日约10～20支。     

血栓闭塞性脉管炎1例

临床资料 患者男，38岁，农民，因双下肢怕冷，发凉，疼痛5年，加重伴右足变黑2个月入院。患者于5年前因受凉后出现双下肢怕冷，发凉，疼痛等不适，未予及时诊治，1年后左足拇趾趾端，第2趾先后变黑，坏死，并于外院分别于“左足拇趾末节截趾术”。     

白癜风、血栓闭塞性脉管炎合并脓疱性银屑病一例

患者男,43岁.因双下肢怕冷、发凉、间歇性跛行8年,加重伴左足第3、4、5趾疼痛、坏死2个月入我院脉管炎科住院治疗.由于全身泛发白斑20年,躯干、四肢起鳞屑性红斑,反复发作3年,掌跖部脓疱10天请我科会诊.患者20年前,左小腿胫前外伤诱发色素脱失.因白斑进展迅速,分布广泛而放弃治疗.8年前,无诱因出现双下肢怕冷、发凉、间歇性跛行,渐加重.2个月前,出现左足疼痛,第3、4、5趾逐渐变黑坏死.3年前,躯干、四肢散在出现红斑、丘疹,上覆白色鳞屑,每于冬春季复发,外用药物可愈.10天前,双手足掌跖部突然出现皮下深在性脓疱伴角化脱屑,痒.患者父母非近亲结婚.否认家族中有同类病病史.既往有吸烟史,日均约20支.     

闭塞性血栓性脉管炎合并鱼鳞病一例

临床资料患者,男,45岁。因双手指端潮红、发凉、坏死2年,双前臂伸侧皮肤干燥1年就诊。2年前患者无明显诱因双手出现苍白、潮红、发凉等现象,未引起患者重视,2个月后双手无名指指端先后出现胀痛、溃烂,形成黑色结痂,就诊于当地某医院,诊断不明,具体治疗不详,4个月后指端自行脱落,1年前右手食指再次出现上述症状,伴双前臂伸侧出现干燥、脱屑,皮肤粗糙,冬季加重,夏季减轻。     

闭塞性血栓性脉管炎1例

患者男,28岁.双足发冷,阵发性发白、发绀8个月,双小腿肌肉疼痛6个月,表面无红肿,未予重视.4个月前,患者右足第2趾末端出现红肿、化脓,形成溃疡伴痒痛,以夜间疼痛剧烈,在当地医院按照"甲沟炎"诊治,无明显好转.     

红外热温差检测血栓闭塞性脉管炎与局限性硬皮病16例

本文报告试用AGA-750热象仪检测10例血栓闭塞性脉管炎和6例局限性硬皮病,测得两组26处温差数据。并运用红外成象原理结合临床对检测结果进行探讨,初步肯定本技术用于皮肤科临床的可行性。     

副肿瘤性肢端角化症并发脑萎缩及血栓闭塞性脉管炎一例

患者男,62岁,于1978年头皮、背部及四肢伸侧出现鳞屑性红斑,诊断为“副银屑病”,给予丹参注射液静脉滴注后皮疹大部分消退。1982年皮疹复发,并出现指节垫及掌跖角化,再用丹参治疗则效果较差;用白血宁、乙亚胺或甲氨喋呤等药物治疗可控制皮疹。1994年起,自服乙亚胺亦不能控制发疹,鳞屑红斑逐渐增多,并遍及全身,瘙痒呈进行性加重。1995年初,左颈部锁骨上出现蚕豆大小淋巴结1个,活动,无粘连。表皮无红肿及破溃,尔后又于其周围陆续出现蚕豆大小淋巴结3个于1996年9月住院治疗。体检:血压24/14kPa,各系统检查无异常。皮肤科检查:头皮大片红斑及糠…     

120例闭塞性血栓性脉管炎护理体会

我所自 1993年以来共收治闭塞性血栓性脉管炎患者 12 0例 ,经过近 10年的临床经验总结 ,我们认为闭塞性血栓性脉管炎的临床早期诊断、治疗是防止出血坏疽的关键 ,临床护理同样也是患者治愈康复的重要因素 ,现将护理体会介绍如下。1　临床资料12 0例患者中男 98例 ,女 2 2例 ,患     

恶性黑素瘤误诊为脉管炎1例

临床资料 患者，男71岁。右足拇趾溃疡不愈半年。于2002年12月发现右足拇趾外侧出现指甲盖大小黑斑，自行弄破后溃疡不愈，曾在市内某家医院诊断为“脉管炎”给予治疗半年无明显效果，且在足拇趾溃疡处长出黑色肉芽，表面凹凸不平，触碰易用出血，于2003年7月14日来我科就诊。皮肤科情况：右足拇趾外侧有     

Buerger's disease (thromboangiitis obliterans)

Thromboangiitis obliterans (TAO) is a segmental, inflammatory, vasoocclusive disease that predominantly affects the small and medium-sized arteries and veins of the extremities. It most often occurs in young male smokers, especially those from Mediterranean and Asian countries. It is considered an autoimmune process related to the use of tobacco products. Clinically, it is characterized by the presence of painful, ischemic ulcers of the digits. Histopathological studies usually show an occlusive intraluminal thrombus with a predominantly acute inflammatory infiltrate. To make the diagnosis, it is important to exclude other causes of ischemia of the extremities, and different authors have proposed criteria to establish this diagnosis. Treatment is only effective if it is accompanied by abstention from tobacco. There are also different pharmacological and surgical strategies for its management.     

老年下肢静脉性皮肤溃疡1例

 报道老年下肢静脉性皮肤溃疡1例。患者女,84岁,因双下肢溃疡伴疼痛1月就诊。皮肤科检查：右足背红肿,见11 cm×4 cm大小溃疡,有脓苔及黑色结痂,内踝见20 cm×5 cm大小溃疡,左小腿散在结痂面。D 二聚体4.81 mg/L。皮损组织病理示：表皮缺失,溃疡面坏死、渗出,毛细血管周围大量炎性细胞,肉芽肿形成。下肢静脉彩超：右小腿见数条肌腱静脉增宽,最宽处约4.8 mm,未见明显血流信息。诊断：右下肢静脉性皮肤溃疡。予低分子量肝素钠针、血栓通冻干粉针抗凝治疗14天及对症处理,出院时溃疡好转但血栓未通;出院后内服中药活血理气汤3周,溃疡恢复,下肢静脉彩超血栓消失。     

Use of duplex ultrasonography in the treatment of thromboangiitis obliterans with iloprost

We present a 34-year-old patient with digital necrosis due to thromboangiitis obliterans. He was successfully treated with iloprost, a prostaglandin analogue. Duplex ultrasonography was performed during the perfusion of iloprost to optimize the doses and the treatment duration. A complete revascularization was observed after 10 days. Iloprost perfusions were stopped, and a slow regression of the necroses was observed in the subsequent days. With the use of duplex ultrasonography, unnecessary high doses of iloprost and long periods of treatment can be avoided reducing side effects and treatment costs.     

Buerger disease (thromboangiitis obliterans): a clinical diagnosis

Thromboangiitis obliterans, or Buerger disease, is a debilitating vascular disease with a well-known pronounced link to cigarette smoking and, more specifically, to the nicotine component of tobacco inhalation. Buerger disease is an inflammatory occlusive disorder that primarily affects the medium and small vessels of the extremities. In the present case report, a 46-year-old man, nonforthcoming smoker, presented to the authors' clinic with a deep ulcer at the head of the second metatarsal. Evidently, although the patient continued to smoke, the ulcer responded to therapy but regressed. Once the history was elaborated, the patient stopped smoking, and the ulcer healed completely within 2 months. Follow-up appointments proved to be unremarkable and to the authors' knowledge, there has not been a reoccurrence, and the patient remains tobacco-free.     

双下肢钙化防御一例

患者,女,56岁。双小腿红斑、结节、溃疡伴疼痛3个月。病史、临床表现结合组织病理学诊断为钙化防御。患者经治疗疼痛症状略改善,皮损无明显好转,2个月后失访。     

Effectiveness of bosentan in the treatment of ischemic lesions in a case of thromboangiitis obliterans (Buerger disease): a case report

Buerger disease or thromboangiitis obliterans (TAO) is a thrombotic occlusive, non-atherosclerotic segmental inflammatory disease that affects the small and medium-sized arteries and veins in the extremities of the limbs, frequently requiring amputation. Cessation of tobacco use is the only known effective treatment, though preliminary results from the use of pharmacological therapy implicated in pathogenesis of TAO have demonstrated noticeable clinical improvement of patients. We report the case of a 35-year-old woman with active TAO, refractory to smoking cessation and conventional therapy, who exhibited a favorable clinical response to treatment with bosentan, an oral dual endothelin receptor antagonist, administered on a compassionate-use basis. Six months after starting bosentan therapy, the pain and trophic lesions in the patient's toes had completely disappeared. Bosentan was well tolerated, without any observed adverse reaction. The findings of this case report suggest that bosentan may be considered a therapeutic option for patients with active disease, despite quitting smoking, or for those who fail in absolute abstention from smoking.     

下肢烧伤瘢痕继发鳞状细胞癌1例

<正>临床资料患者,男,41岁。主因右下肢烧伤瘢痕处增生、溃疡3年加重1年,于2007年4月来我院就诊。患者11岁时右下肢烧伤愈后遗留瘢痕,近3年来自觉瘢痕中部瘙痒,搔抓后易破溃出血,渐高起,破溃处反复结痂、破溃,创面难以愈合,曾在当地以皮     

掌跖银屑病误诊一例

患者男，18岁。因双手掌大鱼际及虎口处红斑、鳞屑2年于2006年6月20日来我院就诊。2年前，双手掌虎口处无明显诱因出现黄豆大红斑，上覆少许鳞屑，无明显症状，未治疗，后皮损渐扩大至大鱼际处（图1），有瘙痒感，遂到医院求治。当地医生按手部湿疹给予曲安西龙片、抗组胺药及外用药物等治疗，曾有所好转，以后又逐渐加重，皮损渐扩大。家族中无类似疾病史。一周前，右足内侧缘发现豆大红斑、其上少许鳞屑，无明显症状。检查发现，其双足底部散在分布数个豆大至甲盖大红斑，其上有少许鳞屑，用棉签轻刮皮损可见薄膜现象及Auspitz征。[第一段]     

落叶型天疱疮误诊一例

<正>临床资料患者,女,81岁。主因右面颊部红斑痂皮伴刺痛、瘙痒5月余,周身多发红斑、水疱伴痒10 d,于2013年1月8日就诊。患者5个月前无明显诱因先于右侧颞部出现散在肉色丘疹,无痛痒不适,于当地医院就诊,颞部皮损组织病理检查考虑鲍恩病。遂给予5-氨基酮戊酸光动力疗法(ALA-PDT)治疗3次,治疗期间皮损无好转,渐往外扩展,转为粉红色、黄褐色结痂,累及整个右侧面颊,局部有刺痛、     

人工皮炎误诊一例

患者女,46岁,家庭妇女.因面、胸背红斑10个月,臀部红斑、溃疡伴疼痛6个月由其亲戚陪伴于2009年3月来我中心就诊.患者仅提供6份既往诊疗病历,拒绝提供病史.在当地医院多次就诊病历均无病史记录,未予实验室及组织病理检查,诊断有"湿疹、接触性皮炎、SLE、天疱疮、脓皮病"等.给予泼尼松、氯雷他定、酮替芬等口服,糖皮质激素及抗生素制剂外用,症状均无明显改善.体检:神志清楚,一般情况可,各系统检查未见异常.皮肤科情况:面部、前胸两乳房间、后背可见条索或不规则片状分布的暗红色斑片,部分斑片表皮缺如,可见陈旧性浅表糜烂面.臀部可见大片状暗红斑,部分表皮缺损呈虫蚀样糜烂、溃疡,创面洁净,无明显分泌物,境界较清,周边无红晕.初步拟诊:红斑型天疱疮?人工皮炎?取臀部浅表糜烂处组织病理检查:切片中部表皮缺失,其下浅层胶原纤维变性,两侧表皮轻度增厚水肿,真皮浅层血管周围淋巴细胞浸润,符合人工皮炎改变.诊断:人工皮炎.