复杂带状疱疹合并内脏反应个案报道

1病例摘要患者吴××,男,81岁,因右侧胸肋部间断疼痛6d,皮疹2d于2006年9月14日收入我院治疗。右侧胸肋部集簇性丘疹、丘疱疹,呈带状分布,阵发性刺痛,右下腹壁肌肉阵发性痉挛状疼痛,疼痛以静息状态为重,影响睡眠,伴有颈部不适,抬头困难;右上肢无力,右手准确性差;右下肢局部跳痛、无力,共济失调;右侧胸腹部皮肤敏感;自觉胃部不适,腹胀,小肠肠鸣音活跃,便秘。体格检查:系统检查未见异常。皮肤科检查:自8、9、10胸椎沿右侧周围神经呈带状分布集簇性丘疱疹,很快形成水疱,水疱互相融合形成大疱,疱内容物澄清,水疱吸收、结痂、脱落,留有色素沉着。…     

隔姜灸配合抗病毒治疗带状疱疹45例

目的:观察隔姜灸配合西药抗病毒治疗带状疱疹的临床疗效.方法:对照组仅采用西药抗病毒治疗,治疗组在此基础上配合隔姜灸治疗.将两组的疗效及症状改善的时间进行对比观察.结果:治疗组的总有效率为97.8%,对照组的总有效率为77.8%,而且治疗组改善症状所需时间明显短于对照组,差异有显著性(P＜0.05).结论:隔姜灸配合西药抗病毒治疗带状疱疹疗效更确切,更明显,且简单易操作,易于推广.     

会阴部带状疱疹致急性尿潴留1例

患者，女，28岁，因外阴部及右下肢起水疱伴疼痛6d来诊。患者于10d前身体出现类似感冒症状，不久自觉右下肢及会阴部疼痛，很快出现簇集性水疱，波及右侧阴唇及骶部。     

肝移植后纤维化胆汁淤积性肝炎的临床病理特点

慢性乙型肝炎病毒(HBV)感染已成为世界性严重问题．全世界目前超过20亿人感染HBV，每年因HBV感染造成的死亡数高达1百万。丙型肝炎病毒(HCV)感染者达3亿．病毒携带者达1亿7千万，其中80％转为慢性．20％发展为肝硬化，1．5％发展为肝细胞癌。我国现有约1．2亿HBV携带者，HCV感染率估计为3．2％。原位肝移植(OLT)目前已成     

带状疱疹及带状疱疹后神经痛的治疗进展

带状疱疹(herpes zoster,HZ)及带状疱疹后神经痛(postherpetic neuralgia,PHN)多见于老年人.随着人口老龄化,其发病率呈增加趋势.目前,对PHN的治疗仍十分困难.HZ早期有效的治疗,有利于缓解急性期疼痛、缩短病程和预防PHN发生.近几年来对HZ及PHN治疗进行了广泛的临床研究和实践,治疗方法更多,疗效有一定提高.本文就目前推荐的治疗方法及进展加以综述.     

梅花针治疗带状疱疹后神经痛37例

带状疱疹是皮肤科常见病、多发病 ,由水痘带状疱疹病毒引起 ,以沿神经分布的群集水疱及神经痛为主要特征 ,与中医文献记载的“缠腰火丹”、“蛇串疮”、“蜘蛛疮”等相似。在临床上经抗病毒、营养神经、止痛、对症及应用皮质类固醇激素治疗或配合中医辨证论治 ,大部分病人均能痊愈 ,且获得终身免疫。部分病人在皮疹消退后遗留顽固性神经痛 ,经久不愈 ,尤以 4 0岁以上患者为著。近 2年来 ,笔者采用梅花针治疗该病 ,取得显著疗效 ,现报道如下。1　临床资料37例中男 17例 ,女 2 0例 ;年龄 2 2～ 77岁 ,平均(44 35± 17 37)岁。病程最短 30d ,…     

腹膜透析合并带状疱疹一例

临床资料 患者：女，65岁。因“规律腹膜透析2年，左侧背痛2d”于2010年6月1日收住院。患者有2型糖尿病病史12年，2g前因“反复恶心、呕吐”检查血肌酐824μmol／L，双肾CT示双肾萎缩，诊断为慢性。肾脏病5期，开始维持性腹膜透析治疗，使用1．5％、2．5％葡萄糖腹膜透析液每日各2次间隔留腹，病情稳定，规律治疗至今。2d前于劳累后出现左侧背部持续性、针刺样痛，出现腹水浑浊1次，疑为腹膜炎，收住院。     

带状疱疹及带状疱疹后神经痛的治疗进展

带状疱疹(herpes zoster，HZ)及带状疱疹后神经痛(postherpetic neuralgia,PHN)多见于老年人。随着人口老龄化，其发病率呈增加趋势。目前，对PHN的治疗仍十分困难。HZ早期有效的治疗，有利于缓解急性期疼痛、缩短病程和预防PHN发生。近几年来对HZ及PHN治疗进行了广泛的临床研究和实践，治疗方法更多，疗效有一定提高。本文就目前推荐的治疗方法及进展加以综述。     

泛发性带状疱疹一例

1临床资料患者,女,58岁,因左侧颈部、双肩、臂部红斑、水疱疼痛5天,伴头痛、头晕全身无力2天来就诊。患者5天前无明显诱因出现左侧颈部针刺样疼痛,昼轻夜重,偶可放散至左上肢,自行拔火罐治疗2天,疼痛略有减轻。2天前发现左侧颈部、双侧肩背部、双上肢出现小片状红斑及米粒大小的水疱,疼痛较前加重,并出现头晕、头痛伴全身无力症状,无     

局部浸润阻滞治疗带状疱疹后遗神经痛伴瘙痒一例

患者男，57岁，以带状疱疹后遗神经痛入院。1月前患者右侧胸壁沿T3～T5肋间神经走行皮肤出现疱疹，经治疗后皮损治愈，但该处皮肤出现剧烈针刺样疼痛，VAS评分为10分。     

Myelopathy after zoster virus infection in immunocompetent patients: A case series

ContextAfter primary infection, varicella zoster virus (VZV) becomes latent in ganglionic neurons. If immunity declines, VZV is reactivated and can spread to the dermatome depending from this ganglion and in some cases to the spinal cord. Myelopathy is rare and may develop in the absence of skin rash making the diagnosis very difficult.FindingsFrom 1994 to 2014, we collected five observations of clinically and laboratory confirmed zoster myelopathy. The age of our patients ranged from 14 to 78. They did not have any significant past medical history. Four patients had a history of radicular rash. After 3 weeks (4–45 days), patients presented paraparesis, sensory loss, and sphincter dysfunction. Cerebrospinal fluid (CSF) analysis revealed an elevated protein level (5/5cases) and pleocytosis (2/5 cases). Spinal cord magnetic resonance imaging (MRI) demonstrated T2 hyper intense lesions with swelling and contrast enhancement. The diagnosis was supported by laboratory evidence, including the detection of VZV antibodies in the CSF. All patients received intravenous acyclovir and two patients received IV methylprednisolone. A marked improvement was observed in most of the patients within 2 months.Conclusion /Clinical RelevanceBased on our patients and on previous reports, we highlight the possibility of the occurrence of VZV myelopathy in immunocompetent subjects. The diagnosis must be evoked even in the absence of typical skin lesions. In this case, spinal cord MRI and virological tests are useful tools for the diagnosis. We also emphasize on the importance of accurate diagnosis to enable the specific treatment and ameliorate the outcome.     

Loss of urinary voiding sensation due to herpes zoster

A case of sacral herpes zoster infection in a 56-year-old man with the complication of loss of urinary voiding sensation is presented. He had typical herpes zoster eruption on the left S2 dermatome, hypalgesia of the S1-S4 dermatomes, and absence of urinary voiding sensation. There was no other urinary symptom at the first medical examination. Urinary complications associated with herpes zoster are uncommon, but two types, acute cystitis and acute retention, have been recognized. No cases of loss of urinary voiding sensation due to herpes zoster have been reported. In this case, hypalgesia of the sacral dermatomes was mild compared to the marked loss of urethral sensation. This inconsistency is explained by the hypothesis that the number of urethral fibers is very small as compared to that of cutaneous fibers, therefore, urethral sensation would be more severely disturbed than cutaneous sensation.     

Increased risk of a herpes zoster attack in patients receiving androgen deprivation therapy for prostate cancer

This study aimed to examine the association of herpes zoster (HZ) with androgen deprivation therapy (ADT) use among patients with prostate cancer (PC), using a population‐based data set. The study sample for this study was retrieved from the Taiwan Longitudinal Health Insurance Database 2005. We selected 877 patients with PC who had received ADT as the study group, while 849 patients with PC who had not received ADT served as the comparison group. Each study patient was individually tracked for a 3‐year period to discriminate those who subsequently received a diagnosis of HZ. Of the total 1,726 sampled patients, the incidence rate of HZ per 100 person‐years was 1.80 (95% CI: 1.41–2.25) during the 3‐year follow‐up period. In particular, incidence rates of HZ per 100 person‐years were 2.36 (95% CI: 1.75–3.13) and 1.24 (95% CI: 0.81–1.81), respectively, for patients with PC who had and those who had not received ADT. Furthermore, Cox proportional hazard regressions showed that the adjusted hazard ratio for an HZ attack during the 3‐year follow‐up period for patients with PC who had received ADT was 1.88 (95% CI: 1.13–3.11) than those who had not received ADT. We concluded that patients with PC who had received ADT had an increased risk of HZ.     

Varicella pneumonia in an immunocompetent adult: A case report

The clinical presentation of varicella in adults is frequently associated with complications, particularly varicella pneumonia. Most cases occur in immunocompromised adults but immunocompetent can have serious pulmonary compromise. We report the case of an immunocompetent patient admitted to the intensive care unit with dyspnea and an exanthematous vesicular rash. We diagnosed varicella pneumonia based on the presence of a typical skin rash, pulmonary symptoms and contact with a child with chickenpox, confirmed by positive serology of varicella zoster virus (VZV). The patient made a full recovery with mechanical ventilation and anti-viral therapy.     

肾移植术后带状疱疹的特征及诊治

目的 探讨肾移植患者术后带状疱疹的诊治特点.方法 回顾性分析我院1991年1月至2007年1月30例肾移植术后并发带状疱疹患者的临床资料.结果 肾移植患者术后带状疱疹的发病率为1.5%(30/2037),低于早期国外的报道.发病时间从术后2个月到90个月不等,平均为19.5个月,66.7%(20/30)发生于术后1～2年.18例表现为寻常型,12例为特殊型.5例合并局部细菌感染,6例合并全身性感染.常规予抗病毒、应用丙种球蛋白及局部治疗;表现较重者适当调整免疫抑制方案,合并其他感染者采取相应抗感染治疗.所有患者皮肤带状疱疹恢复良好,3例因同时伴有其他严重感染死亡,表现较重者调整免疫抑制方案后迅速恢复.1例合并角膜疱疹者恢复较慢,恢复后视力未受影响.5例合并慢性移植物肾病者治疗期间应用超过10 d的静脉抗病毒治疗后血清肌酐值上升12～25 μmol/L,停药或改用口服用药后恢复.1例调整免疫抑制方案后发生急性排斥,经应用甲泼尼松冲击治疗后恢复.结论 肾移植术后易并发带状疱疹,其病情常较重,病程也较长.发生的带状疱疹易累及非典型部位或合并其他感染.治疗时需要进行综合治疗,并需密切观察病情,必要时调整免疫抑制治疗方案.     

乙肝相关性肝癌抗病毒治疗临床研究

目的对已确诊的乙肝病毒感染相关性肝癌患者进行抗病毒治疗的临床意义进行初步探讨。方法按治疗方法不同将肝癌患者分为TACE组,射频消融组,姑息治疗组,每组均设试验组及对照组,试验组给予口服阿德福韦酯联合拉米呋啶抗病毒治疗,对照组给予常规治疗,观察组间的肝功能乙肝病毒载量变化,观察TACE及射频消融组的TTP,1年生存率,观察姑息治疗组的OS。结果 TACE组中试验组有10个月的肝功指标较对照组好,其中8个月有统计学意义;射频消融组中试验组有11个月的肝功指标好于对照组,其中10个月有统计学意义;姑息疗组用药后第1个月的肝功指标试验组好于对照组,差异有统计学意义。TACE组及射频消融组应用抗病毒治疗后乙肝病毒DNA复制水平均明显下降,姑息治疗组抗病毒治疗后初期,乙肝DNA复制水平也有所下降。TACE组中试验组的TTP为4.1个月,1年生存率61%,对照组TTP为4.2个月,1年生存率59%;射频消融组中试验组的TTP为7.2个月,1年生存率77%,对照组为6.9个月,1年生存率79%,差异均无统计学意义,姑息治疗组中试验组的OS为2.8个月,对照组为3.1个月,无统计学差异。结论在肝癌相关治疗的基础上联合抗病毒治疗可有效降低病毒载量、延缓肝功能的恶化速度,提高患者生存质量。     

A case of herpes zoster ophthalmicus with complete ophthalmoplegia

A 58-year old man with herpes zoster ophthalmicus developed complete ophthalmoplegia, dissemination of herpetic lesions and meningitis. Eye movements improved two month after the onset of zoster. Five months later, eye movements recovered completely, but his sight was disturbed severely due to corneal ulcer.