后板层角膜移植治疗大泡性角膜病变的动物实验研究

目的 探讨后板层角膜移植术治疗大泡性角膜病变的可行性。方法 建立大泡性角膜病变动物实验模型。设实验组和对照组：实验组6只兔在模型建立后l周对6只眼进行后板层角膜移植术，术后每日观察结膜充血、角膜水肿和新生血管生长情况，于术后3月摄像记录，取角膜做病理切片检查。对照组6例同样建立模型，在实验结束时亦取角膜进行病理切片检查。结果 实验组：角膜植片成活，裸眼观透明。状况评价为O级4眼；l级2眼。病病切片示基质层胶原纤维平行于角膜表面排列，前板层自体角膜胶原纤维排列紧密，移植的后板层胶原纤维排列疏松。对照组：角膜混浊，基质浅层见精大、明显的新生血管长入。角膜状况评价为3级l眼、4级2眼；病理切片示全角膜厚度为正常的2倍，角膜基质浅层出现新生血管，平行于角膜表面，上皮增生，有淋巴细胞浸润，上皮细胞增殖、排列紊乱。结论 后板层角膜移植术是一种新的、可供选择的治疗大泡性角膜病变方法之一。     

Chronic cicatrizing conjunctivitis: A review of the differential diagnosis and an algorithmic approach to management

Cicatrizing conjunctivitis constitutes a group of chronic local and systemic disorders that cause conjunctival scarring. A systematic approach is required to sift through the clinical history, examination, and laboratory investigations of patients to arrive at the correct diagnosis of the underlying cause. Establishing the etiology is critical, as the therapeutic approach changes based on the cause of conjunctival inflammation. Effective management of patients with the condition requires knowledge of multiple modalities such as systemic immunosuppressive therapy, use of scleral contact lenses, and surgery for ocular surface and vision improvement. We review the clinical features of this condition and present diagnostic and treatment algorithms to help simplify the complexities in its management. This review attempts to place all the relevant information on chronic cicatrizing conjunctivitis together in one place for the benefit of cornea and ocular surface specialists, general ophthalmologists, and ophthalmology residents.     

Intubação seletiva do brônquio principal esquerdo em unidade de terapia intensiva neonatal

Background

Selective neonatal left mainstem bronchial intubation to treat right lung disease is typically achieved with elaborate maneuvers, instrumentation and devices. This is often attributed to bronchial geometry which favors right mainstem entry of an endotracheal tube deliberately advanced beyond the carina.

Mast Cells and Immunological Skin Diseases

Mast cells play an important role in both adaptive and innate immunity, and a large body of literature demonstrates their functions in skin immunity. This article reviews the literature on the role of this cell type in the pathogenesis of a number of immunological skin diseases, including contact dermatitis, atopic dermatitis, immunobullous disease, scleroderma, and chronic graft-vs.-host disease. In all these diseases, mast cells are noted to increase in number and undergo degranulation in the affected skin, and in some cases, their specific mediators are detected. Elucidation of the contribution of mast cells to the pathogenesis of these diseases has been aided significantly by the use of animal models, especially mouse models. The studies of mast cell-deficient mice in conjunction with normal congenic mice have been particularly fruitful, although in some cases, such as contact dermatitis, a definitive conclusion has not been achieved despite extensive efforts. The role of mast cells in atopic dermatitis has also been suggested by studies of gene polymorphism, which have linked some of the mast cell-related genes to the disease. In the case of scleroderma and chronic graft-vs.-host disease, the function of mast cells in fibrosis is further supported by the ability of these cells and their mediators to induce activation and proliferation of fibroblasts. Therapies targeting mast cells may prove beneficial for treatment of these inflammatory and autoimmune diseases.     

Dysphagia in dermatologic disease

Disorders of the oral cavity, pharynx, and esophagus may be found in some dermatologic diseases. The connective tissue diseases especially may be accompanied by dysphagia. Furthermore, some rare inflammatory and bullous dermatologic diseases can lead to esophageal disorders. Finally, some infectious and malignant diseases occurring in human immunodeficiency virus (HIV)-infected patients cause dysphagia (Table 1). The following discussion presents a comprehensive review of these diseases and their typical esophageal dysfunction.     

环磷酰胺冲击治疗120例老年大疱性皮肤病患者的血象水平及相应感染研究

目的分析环磷酰胺冲击治疗应用于老年大疱性皮肤病患者的疗效及患者血象水平变化与感染情况。方法将我院皮肤科240例老年大疱性皮肤病患者随机分成两组各120例，对照组运用糖皮质激素治疗，实验组以环磷酰胺行冲击治疗，分析两组患者血常规水平及相应的感染情况。结果实验组总显效率高于对照组，组间差异有统计学意义。两组治疗前后平均白细胞总数与中性粒细胞数、血红蛋白与血小板含量均无太大变化，无统计学差异。两组感染率组间差异无统计学意义。结论环磷酰胺冲击治疗老年大疱性皮肤病，效果确切，安全、可靠，值得应用；治疗过程中应注意对感染的预防。     

Skin autoimmunity and blood coagulation

Evidence exists that the immune and coagulation systems are simultaneously activated in some systemic autoimmune disorders. Although proinflammatory mediators induce tissue factor (TF) expression, the main initiator of blood coagulation, activated proteases of coagulation may act on protease-activated receptors (PAR) triggering inflammation. Such a cross-talk amplifies and maintains the activation of both systems. This review focuses on the involvement of immune and coagulation system in two skin disorders as chronic urticaria (CU), autoimmune in about 45% of cases, and bullous pemphigoid (BP), the prototype of autoimmune blistering diseases. Several investigators demonstrated the activation of coagulation in CU through the involvement of eosinophils, of TF pathway with thrombin generation and increased vascular permeability. Preliminary data indicate that anticoagulant treatment with heparin and warfarin may be effective in reducing the symptoms of this disorder. The activation of coagulation seems to display local and systemic implications in BP. Eosinophils' recruitment and thrombin generation locally contribute to the bulla formation and tissue damage. The systemic activation of coagulation may explain the increased thrombotic risk observed in these patients. Taken together, these data provide the rationale for proposing clinical trials on the anticoagulant treatment in both CU and BP patients.     

Invasive squamous cell carcinoma of the hand in a patient with Kindler syndrome: Case report and literature review

Kindler syndrome is a rare, autosomal, recessive genodermatosis characterized by trauma-induced acral blisters in infancy and childhood, photosensitivity and progressive poikiloderma. Very few cases in the literature report an association with squamous cell carcinoma, even though it is a very well-known, long-term complication. A case involving a 23-year-old woman with a history of Kindler syndrome who was admitted to the department of plastic surgery (Sherbrooke University, Sherbrooke, Quebec) with an extensive ulcerated squamous cell carcinoma of the right hand is presented. A local excision of the tumour was initially performed, but positive margins and clinically palpable axillary lymphadenopathy over the course of hospitalization necessitated below-elbow amputation and lymph node dissection. To the authors’ knowledge, this is the second reported case of aggressive metastatic squamous cell carcinoma of the hand in a patient with Kindler syndrome.