复方甲硝唑栓联合倍美力软膏治疗老年性阴道炎的临床研究

目的：探讨复方甲硝唑栓联合倍美力软膏治疗老年性阴道炎的临床疗效和安全性。方法：选取2011年1月至2012年12月来本院妇科就诊的老年性阴道炎患者共130例作为研究对象。根据入院时间将患者随机分为观察组和对照组,每组各65人。对照组采用甲硝唑栓进行治疗,观察组加用倍美力软膏进行联合治疗。对比两组临床表现改善情况、血清激素水平和临床疗效。结果：治疗后,与对照组相比,观察组白带增多、阴道瘙痒和阴道壁红肿充血症状明显缓解（χ^2=4.33、4.01、6.39,P均〈0.05）;治疗后,与对照组相比,观察组血清FSH水平升高幅度较大（U=8.43,P〈0.05）,E2降低幅度较大（U=5.59,P〈0.05）;观察组治愈率和总有效率分别为63.08%和95.38%,均高于对照组（44.62%,81.54%）（χ^2=4.46、6.10,P均〈0.05）。结论：复方甲硝唑栓联合倍美力软膏治疗老年性阴道炎较单纯应用复方甲硝唑栓具有明显的优势,给药方便,安全可靠,值得在临床上进一步推广。     

乳酸菌阴道胶囊治疗老年性阴道炎临床疗效分析

目的:探讨乳酸菌阴道胶囊治疗老年性阴道炎的临床价值及优越性.方法:将104例老年性阴道炎患者随机分为观察组和对照组,观察组给予乳酸菌阴道胶囊治疗,对照组给予甲硝唑栓治疗,观察两组患者临床疗效、阴道PH值变化及复发率等相关情况.结果:观察组总有效率为94.23%,明显高于对照组的71.15%,组间比较有显著差异(P<0.05);两组患者治疗后阴道 PH值均较治疗前有明显下降(P<0.05或 P<0.01);观察组治疗后阴道 PH值明显低于对照组(P<0.05);观察组复发率为1.92%,明显低于对照组的19.23%,组间比较有显著差异(P<0.01).结论:乳酸菌阴道胶囊治疗老年性阴道炎具有疗效好、复发率低、使用简单等诸多优点,可作为目前治疗老年性阴道炎的一种较佳治疗方案.     

乳酸杆菌活菌制剂治疗阴道炎效果和安全性分析

目的:探讨乳酸杆菌活菌制剂治疗阴道炎的有效性及安全性。方法:选取344例阴道炎患者随机均分为观察组和对照组,观察组采用甲硝唑联合乳酸杆菌活菌制剂治疗,对照组采用甲硝唑治疗,比较两组临床疗效、不良反应发生及随访期间复发情况。结果:观察组细菌性阴道病、念珠菌性阴道炎及滴虫性阴道炎痊愈率和有效率均明显高于对照组,治疗后3、6、9个月复发率低于对照组,差异具有统计学意义(P0.05);对照组不良反应发生率为4.7%(4/86),观察组仅出现3例轻度不良反应,发生率为3.5%,且治疗前后血尿常规及肝肾功能检查指标均无显著性变化(P0.05),两组不良反应发生率差异无统计学意义(P0.05)。结论:乳酸杆菌活菌制剂治疗阴道炎患者安全有效,可在临床上推广。     

保妇康栓联合雌激素软膏治疗老年糖尿病性阴道炎的疗效及对患者生活质量的影响

目的:分析保妇康栓及联合雌激素软膏治疗老年糖尿病性阴道炎的临床治疗效果及对患者生活质量的影响。方法:随机将2013年1月至2014年12月间就诊的100例老年糖尿病性阴道炎患者分为对照组及观察组,每组50例。对照组接受单纯雌激素软膏治疗,观察组接受保妇康栓联合雌激素软膏治疗。对比两组临床治疗效果及治疗前后生活质量变化。结果:在接受治疗前,两组间阴道炎临床症状总积分及生活质量总积分比较,均未见统计学差异(P>0.05),但治疗14d后,观察组阴道炎临床症状总积分明显低于对照组,而生活质量总积分明显高于对照组(P<0.05);而治疗总有效率比较,观察组同样高于对照组(P<0.05)。结论:联合保妇康栓及雌激素软膏治疗方案可在有效的通过老年糖尿病性阴道炎患者临床治疗效果的同时,有效的改善患者的生活质量。     

雌三醇软膏与乳酸菌阴道胶囊联合治疗老年性阴道炎疗效观察

目的:观察雌三醇软膏与乳酸菌阴道胶囊联合治疗老年性阴道炎(SV)的疗效。方法:选取2012年2月至2016年月3在南京市中心医院和南京市第二医院接受治疗的84例老年性阴道炎患者作为研究对象,年龄56~68岁,平均年龄61.5岁,将对象随机分为观察组(42例)和对照组(42例)。观察组患者给予以阴道外用雌三醇软膏0.5mg/次、乳酸菌阴道胶囊0.5g,每晚各1次,连用6周。对照组患者仅用雌三醇软膏或乳酸菌阴道胶囊,其用法、剂量和疗程与观察组保持相同。观察两组治疗后的临床疗效和安全性,并随访治疗后半年的复发率。结果:治疗6周后,观察组患者临床总有效率为95.24%,明显高于对照组使用雌三醇软膏或使用乳酸菌阴道胶囊73.81%(P<0.05),治疗后两组患者虽然出现了一些不良反应,但是不影响后续治疗;随访半年后发现观察组复发3例(7.14%),对照组复发17例(40.48%),观察组患者的复发率明显低于对照组患者的发病率(P<0.05)。结论:雌三醇软膏与乳酸菌阴道胶囊联合治疗老年性阴道炎疗效明显,改善临床症状明显,可降低复发率。     

甲硝唑联合雌三醇治疗老年性阴道炎临床效果观察

目的:探讨甲硝唑联合雌三醇治疗老年性阴道炎临床效果。方法:收集2012年2月至2014年1月来我院就诊的老年性阴道炎妇女100例,随机分为对照组与实验组,两组均有患者50例。对照组患者给予甲硝唑治疗,实验组患者给予甲硝唑与雌激素联合治疗,最后分析与比较两组患者的疗效。结果:实验组患者的总有效率明显高于对照组;实验组患者的复发率明显低于对照组;治疗后实验组患者的阴道炎症评分、健康状况评分、p H值及患者的临床表现均优于对照组。结论:雌激素可以明显提高抗生素治疗老年性阴道炎患者的疗效。     

乳酸菌阴道胶囊联合戊酸雌二醇治疗老年性阴道炎的临床疗效及随访分析

目的:探究与分析乳酸菌阴道胶囊联合戊酸雌二醇治疗老年性阴道炎的临床疗效及随访复发率。方法:选取我院自2013年12月至2015年12月收治的90例老年阴道炎患者,采取随机数字表法分为对照组与观察组,每组各45例,对照组仅在阴道内放置乳酸菌阴道胶囊,观察组在其基础上加用戊酸雌二醇,对比两组患者临床疗效、激素变化及随访半年复发率。结果:对照组总有效率为73.33%,观察组总有效率为93.33%,观察组总有效率明显高于对照组,差异具有统计学意义(P0.05)。两组患者治疗前E2、P、FSH及LH水平相比无明显差异(P0.05)。两组患者治疗后较治疗前相比E2、P、FSH及LH水平虽有改变,但均无明显差异(P0.05)。两组治疗后E2、P、FSH及LH水平分别相比也无明显差异(P0.05)。对照组随访半年复发率为26.67%,观察组随访半年复发率为13.33%,观察组随访半年复发率明显低于对照组(P0.05)。结论:采用乳酸菌阴道胶囊联合戊酸雌二醇治疗老年性阴道炎的临床疗效显著,不会对体内激素水平造成影响,随访半年内的复发率较低,可发挥治疗及预防的双重作用。     

乳酸菌阴道胶囊联合倍美力软膏治疗老年性阴道炎疗效分析

目的:探讨乳酸菌阴道胶囊与倍美力软膏联合应用于老年性阴道炎的疗效分析。方法:选取老年性阴道炎患者74例,随机分为观察组(n=37例)和对照组(n=37例)。两组患者均予以倍美力软膏通过给药器将药物送至阴道,每日1次,每次1.0mg,连用7d,后改为隔日1次,共连用4周。观察组患者在此基础上加用乳酸菌阴道胶囊阴道放置,每晚2粒,连用10d。观察两组患者治疗后1周的临床效果,并比较随访3个月和6个月内的复发率。结果:治疗后停药1周,观察组患者临床总有效率明显高于对照组(94.59%vs.75.68%)(χ2=5.23,P<0.05);观察组患者随访的3个月和6个月内的复发率均明显低于对照组(8.57%and 20.00%vs.32.14%and 50.00%)(χ2=5.61和6.30,P<0.05)。结论:乳酸菌阴道胶囊与倍美力软膏联合应用于老年性阴道炎的疗效较肯定,能迅速缓解临床症状,并能降低其复发率。     

雌激素与二甲双胍联合治疗青春期多囊卵巢综合征的临床疗效分析

目的:探讨雌激素与二甲双胍联合治疗青春期多囊卵巢综合征(PCOS)的临床疗效。方法:选取2014年1月至2015年11月于我院诊治的青春期PCOS患者共95例进行研究,按照随机原则分为观察组(n=48)和对照组(n=47),对照组实施雌激素单药治疗、观察组采用雌激素与二甲双胍联合治疗。比较两组患者治疗前后性激素指标、代谢指标变化情况,评价临床疗效、药物不良反应。结果:两组患者治疗后的性激素指标(T、FSH、LH、DHEAS)均较治疗前降低,SHBG水平较治疗前升高,且观察组各项指标均较对照组改善更明显(P均0.05);治疗后,观察组代谢指标(FBS、TG、FIN)均较治疗前、对照组明显降低,而HDL-C水平明显升高(P0.05);观察组和对照组的治疗总有效率分别为91.67%和72.24%,观察组高于对照组(P0.05);两组不良反应发生情况无明显差异(P0.05)。结论:对青春期PCOS患者行雌激素与二甲双胍联合治疗,患者性激素、代谢激素水平得到有效控制,临床症状明显改善,效果显著,值得推广。     

雌激素补充联合常规治疗多囊卵巢综合征临床观察

目的:探讨雌激素补充联合常规治疗多囊卵巢综合征临床观察。方法:选择2010年1月至2013年10月本院收治的育龄期多囊卵巢综合征患者80例,按照随机数字法分为两组,各40例。对照组使用常规治疗,如药物诱导排卵、心理干预等、生活方式调整等,观察组在对照组基础上联合结合雌激素片治疗。随访2年,比较两组治疗后生殖相关激素水平、治疗不良反应、干预后两组卵巢大小及个数、统计2年内两组妊娠方式及结局。结果:治疗后,观察组E2和PRL水平均基本处于正常,且显著低于对照组(P0.05),骨密度水平高于对照组(P0.05),观察组发生潮热、生殖道干涩、闭经及骨质疏松的比例显著低于对照组(P0.05),观察组卵巢小于对照组(P0.05),卵泡个数少于对照组(P0.05),观察组自然妊娠比例高于对照组(P0.05),未妊娠成功比例低于对照组(P0.05)。结论:雌激素替代治疗能有效的调节多囊卵巢综合征患者性激素水平,改善患者性生活质量,促使患者妊娠成功。     

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.