早泄的诊断与治疗进展

本文主要阐述了早泄的诊断标准,早泄的病因与分析以及早泄的药物治疗和治疗早泄的手术治疗     

Current Diagnosis and Management of Premature Ejaculation

Premature ejaculation (PE) is a common sexual dysfunction characterized by reduced intravaginal ejaculatory latency time (IELT), inability to delay ejaculation, and personal distress. Increasing understanding of pathophysiologic mechanisms has yielded diverse and effective therapies. The current review discusses contemporary evaluation and management of PE, with a review of all randomized, controlled trials (RCT) performed. Therapies with RCT data include behavioral modification/psychotherapy, topical anesthetics, narcotic-like pain relievers, phosphodiesterase-5 (PDE-5) inhibitors, selective serotonin/norepinephrine reuptake inhibitors and receptor antagonists, tricyclic antidepressants, and surgery. As data are insufficient to define optimal therapies, treatment decisions are based on clinical factors (comorbid conditions, PE mechanism and patient preference), trial outcomes, and adverse event profiles. Combination therapies demonstrate superior efficacy to single agents, with concomitant use of behavioral/psychosexual modifications with pharmacotherapy recommended. The role of surgery in PE remains undefined, with additional data required. Further comparative RCTs are required to define optimal treatment algorithms.     

《EAU(2015年版)早泄诊治指南》解读

早泄是一种常见的男性性功能障碍,欧洲泌尿外科学会于2015年3月颁布了《2015版早泄诊治指南》。新《指南》在早泄的定义、发病机制、基于循证医学的流行病、诊断标准、安全而有效的治疗等方面做了论述。通过本《指南》的解读,旨在帮助不熟悉性功能障碍治疗的医生更加正确的诊断和治疗早泄。     

Integrative Approaches to the Treatment of Erectile Dysfunction

Integrative management of erectile disorder (ED) includes focused attention on both medical and psychosocial factors. Recent changes to the psychiatric diagnostic criteria for ED reflect an increasingly quantitative nosology and a shift towards an integrative view of biopsychosocial factors. This article outlines recent research that provides evidence for involving the patient’s partner, where possible, in a patient-centered model for the management of ED. Diagnostic challenges, including possible deficits in physician training and comfort in dealing with ED, are identified, and key elements of an integrative sexual status examination are described. Process-of-care standards for evidence-based practice serve to highlight the importance of integrative treatment. A treatment algorithm—based on these evidence-based guidelines and recent research on integrative and combinative practice—is provided, followed by a discussion of areas of focus for future research.     

Hormonal Approach to the Treatment of Acne

Journal of Cutaneous Medicine and Surgery -     

Practical Approach to the Hormonal Treatment of Acne

Acne is a disease of the pilosebaceous units and these are mainly under hormonal control. In female patients, hormonal therapy is a unique opportunity for the treatment of acne. Several combined oral contraceptives (COCs), cyproterone acetate, spironolactone, flutamide, and others, have been tried for the control of acne. An overview on the use of the most useful drugs in clinical practice was conducted. COCs are thoroughly discussed, also taking into consideration their potential side effects. A practical approach with guidelines on the use of COC in acne is proposed.

     

Practical Approach to the Hormonal Treatment of Acne

Acne is a disease of the pilosebaceous units and these are mainly under hormonal control. In female patients, hormonal therapy is a unique opportunity for the treatment of acne. Several combined oral contraceptives (COCs), cyproterone acetate, spironolactone, flutamide, and others, have been tried for the control of acne. An overview on the use of the most useful drugs in clinical practice was conducted. COCs are thoroughly discussed, also taking into consideration their potential side effects. A practical approach with guidelines on the use of COC in acne is proposed.     

Surgical Approach to the Treatment of Refractory Lesions of Pemphigus Vulgaris

ABSTRACT: A patient with pemphigus vulgaris had lesions on the lip that proved to be refractory to intralesional corticosteroid therapy and to treatment with azathioprine and later to daily administration of 250 mg of prednisone. The patient developed marked cushingoid features and deep vein thrombosis, rendering the continuation of the prednisone therapy unadvisabie. Total vermilionectomy of the affected lip was performed and the prednisone was gradually tapered, taking care that oral lesions remained under control. Eighteen months after the operation, the patient is receiving a single alternate-daily dose of 20 mg prednisone. and both the lip and oral lesions are in remission.     

狼疮脑病及其中西医结合治疗(附32例严重脑病分析)

狼疮脑病，尤其是严重狼疮脑病是系统性红斑狼疮（SLE）的危症之一，它发病急死亡快，处理是否及时得当直接影响SLE的预后。我院结缔组织病专科组经２０多年的临床摸索，诊疗SLE脑病，尤其是严重SLE脑病，不论是紧急发作时的抢救，还是脑病发作后的中西医结合调理等，均有临床体会，现将专科组SLE脑病（１９７４年—１９９３年）诊治情况报告如下。１一般资料在６００例SLE的宏观分析中，有脑损害者（癫痫、精神病、脑器质性损害、感觉改变、交感神经紊乱等）９４例，占１５．７％，其中严重SLE脑病３２例，占脑病的３４％（癫痫型…     

Clinical and Therapeutic Approach to Childhood Acne: An Update

Abstract:   There is a limited literature reporting on acne in childhood. Childhood acne can be classified in neonatal, infantile, mid-childhood, and prepubertal acne, depending on the age of onset. In this review we will present an update on the clinical approach and therapeutic options when facing prepubertal acne in a child. The use of tetracyclines is contraindicated in children younger than 8 years, and oral isotretinoin is not recommended in children younger than 12 years of age according to the FDA and the European Commission. Nevertheless, there are case reports of 10 patients successfully treated with oral isotretinoin for recalcitrant infantile acne with scarring. Further studies are needed to investigate whether isotretinoin may improve the long-term prognosis of infantile acne, which may be associated with more severe acne in adolescence.     

Approach to the jewelry aficionado

Children's and teens’ frequent use of inexpensive “costume” jewelry exposes them to a variety of contact allergens. Greater use heightens the risk of developing allergic contact dermatitis, especially in the setting of body piercings. Several clinical pearls, prevention strategies, and avoidance alternatives are provided in this article to guide clinicians and patients in the management of jewelry‐related allergic contact dermatitis.     

A Selective Approach to Treatment of Ulnar Polydactyly: Preventing Painful Neuroma and Incomplete Excision

Abstract:  Ulnar polydactyly is common. The condition is often successfully treated by pediatricians using string (or suture) ligation in the newborn nursery. Patients with ulnar polydactyly or complications of unsuccessful string ligation such as traumatic neuroma may be referred to pediatric dermatologists. In some cases, the condition is better treated surgically. In case of a bony or ligamentous attachment, surgery is required. Additionally, a wide-base-precluding-string ligation would be better treated with surgery to avoid the need for later revision. We present a series of 10 patients (13 hands) in which previous string ligation produced an unsightly incomplete amputation, a tender neuroma, or both. Patients were successfully treated with completion amputation of the residual stump combined with proximal ligation of the supernumerary digital nerves. We advocate a selective approach in the management of this condition. Treatment options should be fully discussed with families prior to proceeding with suture ligation.