伐昔洛韦抑制疗法和间歇疗法预防生殖器疱疹复发作用比较

目的　比较伐昔洛韦每日抑制疗法和间歇疗法对预防生殖器疱疹复发的作用。方法　 65例复发性生殖器疱疹患者按不同复发频度分层后以半随机方式分配至间歇疗法组 (A组 )和每日抑制疗法组 (B组 )。A组 3 4例 ,当疱疹复发时口服伐昔洛韦 3 0 0mg ,2次 /d ,连服 6天 ;B组 3 1例 ,口服伐昔洛韦 3 0 0mg ,1次 /d ,连服 4个月。治疗后观察随访 6个月。结果　在 4个月治疗期间以及其后 6个月随访期间 ,B组每半年平均复发次数均显著低于A组 (P均 <0 .0 0 1)。结论　伐昔洛韦每日抑制疗法对预防和延迟生殖器疱疹复发具有显著作用 ,疗效明显优于间歇疗法。     

Paucibacillary leprosy: a comparative study of different schedules of multidrug therapy

The study was undertaken to evaluate the efficacy of various multidrug regimens (MDT). Three groups of 10 cases each of Paucibacillary cases were given different schedule of multidrug therapy. First group (T-0) was administered modified WHO regimen consisting of Rifampicin 600 mg once a month, Clofazimine 100 mg alternate days and Dapsone 100 mg daily for 6 months. In second group (T-1) Rifampicin 600 mg was given daily for 6 weeks and in third group (T-2) Rifampicin 600 mg was given daily for 6 months. In both the latter groups Clofazimine 100 mg on alternate days and Dapsone 100 mg daily was also administered for 6 months. Objective clinical scoring was done at the time of admission, three months and six months after treatment in all three groups. The best results were obtained by T-2 followed by T-1; and least effective was T-0 regimen. Pinkish colour of urine and skin was observed in 26 cases and icthyosis in all the cases. All the patients remain under treatment. The work is in progress and subsequent results will be published later.     

Hepatitis and multi-drug therapy in leprosy with special reference to prothionamide

Hepatotoxicity in two drug regimens was studied at Central Leprosy Teaching and Research Institute, Chengalpattu (Tamil Nadu) during 1983-84. In 'P' regimen-prothionamide 350 mg daily, dapsone 100 mg daily and rifampicin 600 mg at monthly intervals were given. In' C' regimen-dapsone 100 mg daily, rifampicin 600 mg once a month and clofazimine 300 mg once a month and 100 mg alternate day were given. Trial was started with fifty multibacillary adult leprosy patients in each group. Enzymatic hepatic dysfunction was noted in 52-58 per cent of the cases even before the therapy was started. In 'P' regimen, four cases of clinical jaundice and six cases of high bilirubinaemia was noticed during the trial as against two cases each of clinical jaundice and high bilirubinaemia in 'C regimen. Of the two cases of clinical jaundice in 'C' regimen, one turned out to be a case of HBV infection. The study which is in progress, indicated higher hepatotoxicity in 'P' regimen which is probably explained by the simultaneous use of two hepatotoxic drugs. Viral hepatitis is endemic in this area and might have aggravated the hepatotoxicity observed.     

特比萘芬合用地巴唑治疗甲真菌病的随机双盲对照研究

目的 观察特比萘芬与地巴唑联合治疗甲真菌病的疗效。方法 甲真菌病患者随机分组,治疗组口服特比萘芬250mg每日1次,同时口服地巴唑10mg每日3次;对照组口服特比萘芬250mg每日1次,同时口服安慰剂。治疗组指甲真菌病疗程为6周,趾甲疗程为8周;对照组指甲真菌病疗程为8周,趾甲疗程为10周。观察2种方法的疗效。结果 治疗后第24周随访,治疗组54例痊愈率为70.4%(38/54例),有效率为83.3%(45/54例);对照组51例痊愈率为66.7%(34/51例),有效率为80.4%(41/51例),两组比较差异均无显著性(P>0.05)。结论 特比萘芬与血管扩张剂联合治疗甲真80.4%(41/51例),两组比较差异均无显著菌病能缩短疗程,且无明显不良反应。     

Calcium dobesilate (Cd) in pigmented purpuric dermatosis (PPD): a pilot evaluation

Pigmented purpuric dermatosis (PPD) is a chronic disorder of unknown etiology. It is quite common, and no therapy is significantly effective. Calcium dobesilate (Cd) has been tried successfully in many vascular disorders. The aim of this study was to evaluate the usefulness and efficacy of Cd in PPD. Nine male patients (7 with Schamberg's and 1 each with lichenoid dermatosis of Gougerot and Blum and lichen aureus) were given Cd 500 mg twice daily for two initial weeks and then 500 mg once daily for a total period of three months. All the patients were followed up for one year after cessation of therapy. The improvement was moderate in 11.11% and mild in 66.67% of cases; 22.22% did not show any improvement. New lesions stopped appearing in two weeks in all patients, and itching also improved in symptomatic cases without any significant side effects. Based upon the results of this pilot study we recommend Cd as the first line therapy for PPD.     

13-cis-Retinoic acid and tetracycline versus 13-cis-retinoic acid alone in the treatment of nodulocystic acne

A comparative clinical study on therapy of nodulocystic acne with 13-cis-retinoic acid was performed in 32 patients. 20 patients were treated with a dose of 1 mg/kg body weight daily, and 12 with a combined therapy: 0.25 mg/kg/day 13-cis-retinoic acid and 0.5 g of tetracycline daily. In both groups the therapy was carried out for 16 weeks. The effect of the combined therapy within 4 months was favourable in 75% of the cases versus 100% in the group treated with larger doses of 13-cis-retinoic acid. Thus, the time needed for clearing was longer in some patients (up to 6 months). However, the incidence of side effects was considerably lower in the group of combined therapy. In acne fulminans 13-cis-retinoic acid alone is not effective and should be combined with corticosteroids.     

伊曲康唑巩固疗法降低花斑癣复发率的临床研究

目的:探讨一种能够降低花斑癣复发率的有效治疗方案。方法:将初诊的花斑癣患者按就诊时间分为两组,均口服伊曲康唑0.2g,每日1次,连续服药7d。7d后对照组停药观察,试验组则继续服用伊曲康唑,每月口服0.2g1次,共6个月。两组患者皆每月复诊1次,共6次。结果:试验组99例患者复发率为1.01%,治愈率为85.86%。对照组95例患者复发率为17.89%,治愈率为64.21%。经卡方检验两组患者的复发率及治愈率相比,差异均有极显著性(χ2=16.4195,P=0.0001和χ2=12.2013,P=0.0005)。结论:巩固治疗方案能在近期内降低花斑癣复发率,同时提高花斑癣的治愈率。     

综合疗法治疗女性迟发性痤疮60例

目的探讨综合疗法治疗女性迟发性痤疮的临床疗效。方法90例患者随机分为两组,综合治疗组60例口服丹参酮胶囊(0.25 g/片)1 g,维胺酯胶囊50 mg,均3次/d,皮损处外搽迪维霜,2次/d,同时进行面部护理,每周1次。对照组30例只口服维胺酯胶囊及外搽迪维霜,方法同上。两组均连续治疗2月。结果综合治疗组与对照组的痊愈率分别为41.67%,26.67%,有效率分别为86.67%,63.33%,差异均有显著性(P<0.05)。结论综合疗法是目前治疗女性迟发性痤疮的一种疗效显著的方法。     

壮医药线点灸对带状疱疹患者临床疗效及血清Th细胞因子的影响

目的探讨壮医药线点灸对带状疱疹患者临床疗效及血清Th细胞因子的影响。方法带状疱疹患者80例,随机分成A、B组,40例/组。A组给予口服泛昔洛韦3次/d,0.25 g/次,实施壮医药线点灸,1次/d。B组仅给予口服泛昔洛韦3次/d,0.25 g/次。10d后比较2组患者临床疗效及治疗前后血清IL-2,IL-4和TNF-α水平变化。结果2组临床有效率分别为77.5%、52.5%,差异有统计学意义(P<0.05);2组治疗前血清IL-2,IL-4和TNF-α差异无统计学意义。A组治疗前后血清IL-2,IL-4和TNF-α差异有统计学意义(P<0.05),B组治疗前后血清IL-2,IL-4和TNF-α差异有统计学意义(P<0.05)。2组在治疗后相比,血清IL-2,IL-4和TNF-α差异有统计学意义(P<0.05)。结论壮医药线点灸联合泛昔洛韦治疗带状疱疹能够提高疗效,并能改善患者血清Th细胞因子水平。     

外用他克莫司与卤米松自身对照和联合治疗白癜风临床疗效分析

目的探讨外用他克莫司与卤米松自身对照、两者联合治疗白癜风的临床疗效及安全性。方法 35例选择对称或者相近部位皮损,分别给予他克莫司2次/d,卤米松1次/d,卤米松采用2周停1周的间歇疗法。8例给予他克莫司与卤米松联合治疗,他克莫司2次/d,卤米松1次/d,卤米松采用2周停1周的间歇疗法。治疗前后测量皮损面积并拍照,用于疗效对照。在共聚焦激光扫描显微镜下观察靶皮损改变。结果他克莫司和卤米松自身对照、联合治疗三者有效率差异无统计学意义。两药起效时间相近,且病程≤12个月的疗效高于病程12个月患者。两药治疗病程≤12个月疗效及病程12个月有效率差异无统计学意义。对于稳定期白癜风,卤米松有效率高于他克莫司。两药治疗进展期和稳定期白癜风有效率均差异无统计学意义。两药联合治疗对进展期白癜风皮损有较好的疗效。两种药物治疗有效的皮损在共聚焦激光扫描显微镜下可见皮损处基底层数量不一的高折光度树突状细胞,分布于毛囊或毛囊之间。结论他克莫司与卤米松、联合治疗均可以有效治疗白癜风,联合治疗并不能明显提高有效率。     

Levels of terbinafine in plasma, stratum corneum, dermis–epidermis (without stratum corneum), sebum, hair and nails during and after 250 mg terbinafine orally once daily for 7 and 14 days

In earlier skin pharmacokinetic studies we have shown that terbinafine is rapidly delivered to the stratum corneum, nails and hair both through sebum and by direct diffusion through dermis epidermis. In the present study the skin pharmacokinetic profile of terbinafine was studied in two groups of eight human male volunteers during and after 250 mg orally once daily for 7 and 14 days. In the 7-day study high terbinafine levels were found in sebum (19.0 μg/g) and stratum corneum (2.5 μg/g), and a concentration in stratum corneum above the minimal inhibitory concentration for most dermatophytes was still found 48 days after the last day of medication. Terbinafine was found in peripheral nail clippings after 7 days of medication and the concentration was, in the 7-day study, 0.5 μg/g 1 day after stopping medication; it was still 0.2 μg/g 90 days after stopping treatment. The results in the 14–day study were in parallel with, but higher than, in the 7-day study. The elimination of terbinafine from several compartments is biphasic, with a faster initial elimination followed by a slower secondary elimination. For nails, the elimination is slower compared with the other compartments. The results indicate that terbinafine may be effective in short-term treatment of several dermatophytoses. The concentration of 0.2 μg/g of terbinafine found in nails 90 days after stopping medication, following 7 days of treatment, indicates that the duration of therapy, even in tinea ungium, may be shorter than is currently the case.     

A comparative study of loratadine versus pheniramine maleate in chronic idiopathic urticaria

Fifty cases with chronic idiopathic urticaria of more than 3 months duration were selected and divided into two groups. Group 'A' was given 10 mg loratadine once daily, while group 'B' was given pheniramine maleate 25 mg, twice daily for one month. All patients were followed for one month more. 48% excellent response was observed in group 'A' while 16% excellent response was observed in group 'B'. Good response was observed in 24% of patients in group 'A', while in group 'B' 16% of patients had good response. No side effects were observed in loratadine group, while drowsiness was observed in pheniramine group.     

Continuous and intermittent itraconazole dosing schedules for the treatment of onychomycosis: a pharmacokinetic comparison

This multicentre, double-blind, randomized study compared the pharmacokinetics of itraconazole given at 200 mg once daily for 3 months and intermittently at 200 mg twice daily for 1 week per month followed by a 3-week drug-free period for 3 months in the treatment of onychomycosis. Patients were followed for 9 months after treatment. Itraconazole and hydroxy-itraconazole plasma concentrations and itraconazole nail tip concentrations were determined at regular intervals. With intermittent therapy (n = 64), increases of consistent magnitude were seen in the mean itraconazole and hydroxy-itraconazole plasma concentrations at the end of each 1-week treatment phase; values returned towards baseline during each subsequent 3-week drug-free period. The mean concentration of itraconazole in fingernail tips increased steadily from week 4, reached a maximum value at week 24 (213 ng/g), declined sharply between weeks 24 and 36 and returned to baseline by week 48; the mean concentration profile was similar for toenail tips (maximum value 305 ng/g at week 24) but decreased at a slower rate. With continuous therapy (n = 65), steady-state mean plasma concentrations of itraconazole and hydroxy-itraconazole were obtained within 4-5 weeks of the start of treatment and remained reasonably constant between weeks 4 and 12. The mean concentration of itraconazole in fingernail tips reached a maximum value at week 12 (524 ng/g) and returned towards baseline by week 48; in contrast, the maximum mean concentration of itraconazole in toenail tips was 698 ng/g at week 36 and did not return to baseline by week 48. No clear relationship was observed between response to treatment and concentration of itraconazole or hydroxy-itraconazole in plasma or itraconazole in nails, suggesting that concentrations exceeded therapeutic levels. In conclusion, intermittent therapy resulted in higher maximum itraconazole plasma concentrations but lower total drug exposure, and hence lower itraconazole nail concentrations, than continuous therapy. However, the intermittent schedule was not associated with a lower cure rate, which indicates that itraconazole nail concentrations remained within the therapeutic range.     

A clinico-pathological study of multidrug regimen in paucibacillary leprosy

Preliminary results of a clinical trial in one hundred untreated paucibacillary leprosy cases with multidrug therapy (MDT) as per WHO recommendation are presented. Out of 100 fresh cases studied 18 had indeterminate, 35 tuberculoid and 47 cases had borderline tuberculoid leprosy. All were given MDT consisting of rifampicin 600 mg once a month and dapsone 100 mg daily for six months. At the end of six months all the cases were evaluated clinically and histopathological examination of lesions were studied. The lesions were still active in 35% of patient clinically and 47% histologically. Complete histological resolution have come across only in 4 cases suffering from indeterminate leprosy. Altogether 65% cases receiving MDT have shown marked improvement to total inactivation. Histologically, lymphocytic infiltration still persisted in 90% of slides examined and nerve infiltration were still present in 64% of cases at the end of six months receiving MDT.     

Evaluation of a therapeutic strategy for the treatment of acne vulgaris with conventional therapy

Four hundred and twenty patients with moderate to severe acne vulgaris were treated with oral erythromycin and topical benzoyl peroxide to determine the optimum dose regimes. Our results show that the response was significantly less in patients with a greater severity of acne, with truncal acne and in those with a higher sebum excretion rate. There was a significantly better clinical result in patients given Ig erythromycin daily than in those given 0.5 g daily (plus topical therapy in both groups). The relapse rate on stopping antibiotics is also significantly less in patients given I g daily and this dosage did not produce any increase in side effects. We suggest that any patient requiring oral antibiotics should initially be given I g daily of erythromycin (or tetracycline) for up to six months, plus topical therapy.     

阿维A联合他扎罗汀治疗原发性皮肤淀粉样变病疗效观察

目的观察阿维A联合他扎罗汀治疗原发性皮肤淀粉样变病的疗效。方法 45例原发性皮肤淀粉样变病患者随机分为两组。治疗组(24例)和对照组(21例)均给予阿维A30mg/d,分3次服用,连续服用4周,改为20mg/d,分2次服用,再服用4周,最后改为10mg/d维持治疗,连用4周,治疗组同时联合外用他扎罗汀,每晚使用1次。两组还同时使用依巴斯汀10mg/d口服、卤米松乳膏每天外用1次。结果疗程结束后治疗组和对照组的有效率分别为70.83%和28.57%,差异有显著性(P<0.05)。结论阿维A联合他扎罗汀治疗原发性皮肤淀粉样变的疗效优于单用阿维A治疗。     

三种方法预防复发性生殖器疱疹疗效观察

目的探讨治疗复发性生殖器疱疹的有效方法。方法 A组42例,伐昔洛韦0.3g,1次/d;B组41例,阿昔洛韦0.4g,2次/d;C组37例,阿昔洛韦0.4g,转移因子6mg,2次/d,疗程均为6个月。结果各组复发率分别为23.80%,29.30%,18.90%,各组间差异无统计学意义。结论采用6个月抑制疗法治疗生殖器疱疹,可有效控制复发。     

Peptide T a new treatment for psoriasis? A study of nine patients.

Nine patients with recalcitrant and long-standing psoriasis were treated over a period of 28 days with 2 mg Peptide T iv, once daily (22-34 micrograms/kg bodyweight). Eight of them showed an improvement of less than 50% by day 28 and one deteriorated. The patients were evaluated for a further 3 months when no topical or systemic treatment was given. Five patients recovered by more than 50%, during the months following termination of the therapy. Two patterns of healing were noted: firstly, a steady clearance beginning immediately with the Peptide T infusions; secondly, a clearance pattern preceded by deterioration. No serious side effects were noted.     

Hochdosierte intravenöse Immunglobulin (IVIG)-Therapie bei therapieresistenter ANCA-negativer, nekrotisierender Vaskulitis

7 patients (5 female, 2 male; age: 22-81 years; average age = 58.1 J) with recurrent necrotizing ANCA-negative, non leucocytoclastic vasculitis, were enrolled into this study. Disease was resistant to prior conservative therapy, and therefore patients received high dose intravenous immuno-globulin (IVIG)--(dose: 1.0 g/kg body weight daily dose 0.25 g/kg body weight over 4 consecutive days). All patients responded rapidly to this therapeutic regimen. Specifically immediate pain relief was striking. Complete clearance of disease was observed in 5 out of 7 patients within 6 months while receiving IVIG (0.5 g/kg body weight) every 4 weeks for one year. In 2 out of 5 patients ulceration and vasculitis healed completely and therapy could be stopped after 6 months. In one patient treatment had to be discontinued due to decreasing kidney function. The data presented demonstrate that IVIG is an effective and valuable therapeutic modality in treatment of severe vasculitis resistant to conventional therapy. However consideration of costs, effectiveness and possible side effects is needed for this therapeutic regime.     

Mohs显微手术治疗乳房外Paget病42例

目的:评价Mohs治疗乳房外Paget病的疗效。方法:42例乳房外Paget病患者沿皮损周围2 cm行Mohs手术切除,确认边缘结果阴性之后行皮瓣或植皮闭合。术后31例患者使用光动力,每周1次,共4次。11例外用咪喹莫特乳膏,每日1次,共半年,随访8~36个月。结果:6例患者复发,复发率14.3%,其中4例为术后光动力治疗患者,2例为术后外用咪喹莫特乳膏。结论:EMPD进行Mohs显微描记手术结合光动力治疗或外用咪喹莫特乳膏有效。