儿童肉芽肿性蕈样肉芽肿

报告1例儿童肉芽肿性蕈样肉芽肿.患儿男,14岁.自6岁起头皮开始出现脓疱,并逐渐脱发,形成浸润性红斑,近年来耳前及左胸部亦出现类似红斑.皮损组织病理检查见典型的表皮内Pautrier微脓肿、异形淋巴细胞浸润及真皮内肉芽肿改变.高倍镜下可见异形淋巴细胞.免疫组化染色显示CD3、CD45RO阳性.诊断:肉芽肿性蕈样肉芽肿.推荐外用糖皮质激素,补骨脂素长波紫外线(PUVA),维A酸及α-干扰素治疗.     

A case of primary cutaneous histoplasmosis in a patient with diabetes and multi-infarct dementia

We report a case of primary cutaneous histoplasmosis in a fifty-year-old African-American woman with diabetes and multi-infarct dementia. The patient developed fever and crusted, nodulo-ulcerative lesions of the skin after accidental superficial trauma to the forehead. The biopsy revealed suppurative granulomatous inflammation with intracellular and extracellular yeast-like cells with associated clear halo measuring 3-4 mm in size. Systemic involvement was not found. The lesions cleared after treatment with itraconazole 200 mg twice a day for 3 weeks. The medication was continued for a total period of 3 months, with no signs of recurrence after one-year of follow-up.     

Decreased incidence of nonmelanoma skin cancer in patients with type 2 diabetes mellitus using insulin: a pilot study

BACKGROUND: In order to prevent the propagation of genetic mutations, human keratinocytes irradiated with ultraviolet (UV) B light in vitro undergo premature stress-induced senescence or apoptosis. This response to UVB irradiation is dependent on the functional activation of the insulin-like growth factor-1 receptor (IGF-1R). Based on this in vitro functional data, we hypothesized that the increased serum levels of insulin in patients with type 2 diabetes may activate the IGF-1R in skin and lead to a decreased frequency of skin cancer in these patients. OBJECTIVES: To determine whether the use of insulin by patients with type 2 diabetes correlated with a change in the incidence in nonmelanoma skin cancer (NMSC). METHODS: A historical cohort study identifying the incidence of NMSC following the use of two different pharmacological therapies. The patient population was restricted to caucasians who were at least 50 years old when they began the indicated pharmacological therapy. The first group consisted of 1440 patients who used insulin therapy to treat type 2 diabetes and the second group comprised 4135 patients who used cimetidine to treat their gastrointestinal ailments. An additional group of 6131 patients with diabetes who used noninsulin antidiabetics was added to examine the effect of noninsulin therapies. All patients had regular follow-up visits at the Regenstrief Clinics during the study period between 1980 and 1999. The Regenstrief Clinics is an outpatient facility which serves the general population in Metro-Indianapolis, Indiana, U.S.A. RESULTS: The incidence of NMSC in patients using insulin was significantly lower than in patients using cimetidine (1.25% vs. 2.35%, P < 0.02). The decrease in NMSC in patients with type 2 diabetes correlated specifically with the use of insulin (NMSC incidence insulin-only patients with diabetes: 1.40% vs. those with diabetes using noninsulin therapies: 2.35%, P = 0.11). CONCLUSIONS: Patients using exogenous insulin had a lower risk of developing NMSC and the protective effect of insulin use becomes more distinct with increasing age.     

Platelet gel in wound treatment in patient with pemphigus vulgaris and Type 2 diabetes mellitus: Case report

Treatment of wounds, especially in patients with systemic diseases, is very difficult and time consuming, and it represents great challenge. Complications like infections and impaired healing are regularly seen in these patients, sometimes leaving almost no other treating option, but amputation surgery. In wound healing process, platelets play one of key roles, both in hemostasis, and, by releasing many growth factors, in reepithelization and tissue remodeling. Platelet concentrates are defined as autologous or homologous platelet derivatives with a platelet concentration higher than it is usually in human blood. Concentration of platelets needed to affect wound healing should be 1,000,000/μl. This is a report about patient with pemphigus vulgaris and Type 2 diabetes mellitus, who got injury of the left lower leg. Traditional surgical methods of wound closure and vacuum‐assisted closure therapy were ineffective. Homologous platelet gel was used topically, resulting in wound closure, without any adverse effects.     

胰岛素泵治疗糖尿病酮症酸中毒伴发肾功能不全的临床研究

目的比较胰岛素泵持续皮下胰岛素输注法（CSⅡ）与传统小剂量胰岛素静脉点滴法治疗糖尿病酮症酸中毒（DKA）伴发肾功能不全的短期疗效。方法DKA并发肾功能不全患者36例,随机均分为CSⅡ组（用胰岛素泵经导管持续皮下输注短效生物合成人胰岛素）和对照组（给予小剂量短效生物合成人胰岛素静滴）。结果CSⅡ组酮体平均消失时间为（22．94±7．89）h,显著短于对照组（38．22±12．29）h,P〈0．05]。CSⅡ组肾功能恢复时间（4．11±2．05）d,显著短于对照组[（6．72±2．87）d,P〈0．051。CSⅡ组调整期各时点（除凌晨3点）的空腹血糖值均低于对照组（均P〈0．05）。CSⅡ组低血糖事件发生次数明显少于对照组（P〈0．05）。结论CSⅡ能更有效地治疗DKA,能更快地改善肾功能,使血酮体转阴,降低低血糖发生率。     

男性2型糖尿病患者性激素水平变化及其相关因素探讨

目的:探讨2型糖尿病(T2DM)男性患者性激素水平变化及其相关影响因素。方法:选取我院2012年1月至2014年8月收治的96例T2DM患者进行研究,根据年龄、BMI、病程、ED严重程度、血糖水平进行分组,比较各组性激素水平变化情况,探讨相关影响因素。结果:T2DM患者IIEF-5评分发病后较发病前降低,差异有统计学意义(P0.05)。不同年龄、病程、BMI的T2DM患者性激素水平对比差异无统计学意义(P0.05)。不同程度ED患者E2、P和PRL对比差异无统计学意义(P0.05)。从无ED到ED严重程度加重FSH、T和LH水平逐渐增高,总体比较差异有统计学意义(P0.05)。不同血糖患者FSH、T、E2、P和PRL对比差异无统计学意义(P0.05)。而血糖低于6.5%的患者LH较另外两组高,整体比较差异有统计学意义(P0.05)。结论:2型糖尿病的发生可能加重勃起功能障碍病情,卵泡刺激素、黄体生成素和睾酮水平与患者血糖及性功能障碍程度相关。     

Neutrophilic Panniculitis in a child with MYSM1 deficiency

Neutrophilic panniculitis (NP) with myelodysplasia has been described in adults but not in children. We report a case of NP associated with myelodysplasia in a child with MYSM1 deficiency, a newly described syndrome with primary immunodeficiency (PI), bone marrow failure, and developmental aberrations.     

The occurrence of type 1 diabetes in patients with dermatitis herpetiformis and their first-degree relatives

BACKGROUND: The increased prevalence of type 1 diabetes (T1D) is well documented in patients with coeliac disease, whereas evidence is scanty in patients with dermatitis herpetiformis (DH). OBJECTIVES: To assess the prevalence of T1D in patients with DH and their first-degree relatives, and to study how DH patients with associated T1D respond to a gluten-free diet (GFD) treatment. METHODS: A series of 1104 consecutive patients with DH was recorded and a specific questionnaire sent to 341 of these for familial disease surveillance. Sex- and age-matched patients with isolated DH served as controls in the diet treatment analysis. RESULTS: Twenty-five (2.3%) patients with DH were affected by T1D and three (3.0%) of their first-degree relatives also were affected by T1D, the frequencies being significantly higher than in the general population. Most DH patients with T1D and with isolated DH could adhere strictly to the GFD. The response was good or moderate in 84% of the DH patients with T1D and in 94% of the patients with isolated DH. CONCLUSIONS: The prevalence of T1D is increased in patients with DH and their first-degree relatives. The rash in DH patients with T1D responds to a GFD in a way similar to that seen in patients with isolated DH.     

The spectrum of histopathologic findings in cutaneous eruptions associated with influenza A (H1N1) infection

Influenza A (H1N1), like many other viral infections, has been associated with cutaneous eruptions. Differential diagnoses in a viral exanthem generally include spongiotic dermatitis, urticaria and drug reaction. The aim of this series was to retrospectively review three cases (five biopsies) involving patients with a clinical history of H1N1 and an accompanying rash, and to evaluate whether unique histopathologic and immunohistochemical features exist among these patients' cutaneous eruptions. Findings among all cases included a sparse superficial perivascular infiltrate, and interestingly, scattered interstitial and prominent intravascular neutrophils. Two cases demonstrated mild spongiosis and mild interface change. Immunohistochemistry in all cases revealed a CD4‐predominant lymphocytic infiltrate of the dermis with a sparse intraepidermal population of admixed CD4 and CD8 positive lymphocytes. Many changes found in the cutaneous eruption associated with H1N1 are similar to those of other viral eruptions, including a mild perivascular lymphocytic infiltrate, mild spongiosis and mild interface change; however, sparse dermal and intravascular neutrophils and intraepidermal lymphocytes appear to be the features unique to these cases of H1N1‐associated cutaneous eruptions. Such a distinction may prove diagnostically important in the clinical setting and useful in the surveillance of this historically pandemic virus.     

Areolar lymphocytoma in a child: A rare cutaneous presentation of borreliosis

Lyme disease is a common tick‐borne infection caused by Borrelia burgdorferi in the United States, where infection is most prevalent in the northeastern and mid‐Atlantic states. Although classically associated with erythema migrans, Lyme disease caused by Borrelia species found in Europe may also present with other cutaneous findings. Here we report the case of a girl who was clinically diagnosed with Lyme disease based on her history of recent travel and the appearance of an areolar lymphocytoma; this was confirmed by testing. Testing for European Lyme disease does not follow the testing algorithm that the Centers for Disease Control and Prevention recommends and may be easily missed. Our case serves as an important reminder that common infections can have varying presentations depending on their region of acquisition and may require specialized testing for accurate diagnosis.