Epithelioid sarcoma‐like (pseudomyogenic) hemangioendothelioma,clinically mimicking dermatofibroma,diagnosed by skin biopsy in a 30‐year‐old man

Epithelioid sarcoma‐like (pseudomyogenic) hemangioendothelioma (ESHE) represents a rare soft tissue and bone tumor that typically presents as nodule(s) in the distal extremities of young adults. The nodules traverse several tissue planes simultaneously and can involve the dermis, subcutis, skeletal muscle and bone. ESHE shares clinical and microscopic features with epithelioid sarcoma (ES), and, accordingly, is commonly misdiagnosed as ES. However, unlike ES, which has a poor prognosis, ESHE commonly follows an indolent course. Herein, we report a case of ESHE diagnosed by skin biopsy that clinically mimicked a dermatofibroma. We also provide clinical photographs of the lesions in various stages of development, representing information that has not been previously published, to our knowledge.     

Immunohistochemical studies on proteoglycan expression in normal skin and chronic ulcers

BACKGROUND: Proteoglycans (PGs) represent a large family of complex molecules. They are found either as integral membrane components or constituents of the extracellular matrix. Their protein backbones are linked to different glycosaminoglycans, such as dermatan-, chondroitin-, keratan- or heparan sulphate. The molecules have specific functions during developmental processes as well as in diseases, such as cancer and inflammation. OBJECTIVES: The expression patterns of various cell-associated heparan and chondroitin/dermatan-sulphate PGs in human skin and chronic venous ulcers were investigated. METHODS: Tissue sections from 11 patients with chronic venous ulcers were used in this study. Monoclonal antibodies were used for detection of the proteoglycans syndecan-1, -2 and -4, glypican, CD44 and perlecan. RESULTS: The different PGs exhibited individual staining patterns. Syndecan-1 and -4 and glypican expression in chronic ulcers differed from the staining in normal skin. Whereas the expression of syndecan-4 and glypican in intact skin was mostly in the pericellular regions of keratinocytes, the epidermal cells from the wound edge contained mostly intracellular PGs. In the wound edge, syndecan-4 was predominantly expressed by epidermal basal layer cells. Syndecan-1 was less expressed at the epidermal wound margins. PGs bind growth factors, regulate proteolytic activity and act as matrix receptors. CONCLUSIONS: The altered expression patterns of glypican and syndecan-1 and -4 in chronic ulcers reflect their possible roles during inflammation and cell proliferation. Hence, analysis of PG expression should be of interest in future studies on normal as well as defective wound healing.     

Resistance to activated protein C due to factor V Leiden mutation: high prevalence in patients with post-thrombotic leg ulcers

BACKGROUND: Activated protein C (APC) resistance is the most frequently diagnosed heritable thrombophilic defect predisposing to thrombosis. OBJECTIVES: To determine the prevalence of APC resistance due to factor V Leiden mutation in patients with leg ulcers. METHODS: Within a 2-year-period 100 consecutive patients with leg ulcers were examined for factor V Leiden mutation. RESULTS: APC resistance due to factor V Leiden mutation was detected in 19 of 53 patients (36%) with post-thrombotic leg ulcers and in three of 47 patients (6%) with ulcers caused by primary varicosis. In a healthy control group APC resistance due to factor V Leiden mutation was found in five of 96 (5%) volunteers. CONCLUSIONS: In view of this high prevalence of APC resistance of 36%, which has never previously been reported, patients with post-thrombotic leg ulcers should be investigated for APC resistance.     

High sensitization rate to emulsifiers in patients with chronic leg ulcers

Emulsifiers are common constituents of most topical preparations. To study the sensitization rate in a population with frequent use of these agents, we selected 47 patients with chronic or recurrent (> 1 year) inflammatory skin disease (leg ulcers, contact dermatitis, atopic dermatitis, psoriasis) for patch testing with the following emulsifiers: Tween 40 (polyoxyethylene sorbitan monopalmitate), Tween 80 (polyoxyethylene sorbitan monooleate), Span 60 (sorbitan monostearate), Span 80 (sorbitan monooelate), Ariacel 83 (sorbitan sesquioleate), Atlas G 2162 (polyoxyethylene oxypropylene stearate), Atlas G 1441 (polyoxyethylene sorbitol lanolin derivative), triethanolamine, Lanette O (cetylstearyl alcohol), Lanette N. 12 patients had at least 1 positive reaction (25.5%) at 3 or 4 days. Among them, 10 had leg ulcers (43.4% of the leg ulcer group), and 2 had contact dermatitis (13.3% of the contact dermatitis group). No positive reaction was observed in the other patients. When the patients were tested with their own topical preparations or wound dressings, 6 of them, all with leg ulcers, had positive reactions. These results show a surprisingly high prevalence of sensitization to emulsifiers in patients with chronic leg ulcers, in contrast to patients with other inflammatory skin diseases.     

护理干预对降低消化性溃疡复发率的影响

目的：观察护理干预对降低消化性溃疡（pepticulcer,PU）复发率的影响。方法：对胃镜检查确诊的PU患者160例随机分为干预组（90例）和对照组（70例）。对照组给予一般常规护理,干预组在对照组基础上给予综合护理干预,平均随访1．3年后统计分析结果。结果：干预组提高了治疗依从性,降低了复发,与对照组比较有统计学意义（P〈0．05）。结论：对PU患者给予生活方式指导、健康教育等护理干预可提高其治疗依从性,从而减少PU的复发,提高患者的生活质量。     

50例消化道溃疡患者的中西医结合治疗效果观察

目的:分析和观察50例消化道溃疡患者的中西医结合治疗效果。方法:选取2010年1月～2012年1月来我院就诊的100例消化道溃疡患者,回顾性将其随即分为治疗组和对照组,对照组是采取西药治疗,连续服用2周,在第3周～第6周给予雷尼替丁治疗;治疗组除了给予上述的西药治疗外,在其基础上服食中药汤药。结果:经过比较后,治疗组的总有效率(98%)高于对照组的总有效率(92%),且两者比较具有统计学意义P0.05;同时,比较两组患者不良反应的发生率,治疗组的不良反应发生率为16%,对照组是52%;两组患者在3年内,治疗组溃疡的复发率要低于对照组的复发率,两组比较差异具有显著性P0.05。结论:中西医相互结合治疗消化道溃疡具有显著效果,且见效快,副作用小,复发率低,值得临床推广和应用。     

Occupational dermatosis among chrome platers

14 (38%) of 37 chrome platers in 17 chrome electroplating factories surveyed had occupational contact dermatitis, chrome ulcers, or both. 7 had chrome ulcers, 6 had contact dermatitis and 1 had both. Another 16 (43%) workers had scars suggestive of previous chrome ulcers. Mucosal irritation was present in 57% of the workers. The most common was throat irritation (49%) followed by nasal irritation (41%). Mucosal irritation was more common in hard chrome platers, while skin ulcers and dermatitis were more common in bright chrome platers. Nasal septum perforation was seen in 1 worker. Skin ulceration appeared to be a more specific sign for occupational dermatosis in chrome platers than dermatitis when the prevalence rates were compared to controls. Of the 7 workers with chrome ulcers, only 1 was allergic to chromate. Of the 6 workers with dermatitis, 2 were allergic to chromate and 1 to nickel. The worker with ulceration and dermatitis was negative to chromate and nickel. Irritant factors are therefore important in the aetiology of contact dermatitis in these chrome platers.     

益气养阴生肌方配合西药治疗复发性阿弗他溃疡的疗效观察

目的观察益气养阴生肌方配合西药治疗复发性阿弗他溃疡的临床疗效。方法将112例复发性阿弗他溃疡患者随机分为2组,对照组56例采用局部封闭治疗,治疗组56例在局部封闭治疗基础上予益气养阴生肌汤口服。2组疗程均为4周,疗程结束后观察随访治疗后6、12个月临床疗效。结果治疗后随访6、12个月治疗组总有效率均明显高于对照组(P<0.05)。结论益气养阴生肌方配合西药治疗复发性阿弗他溃疡疗效满意。     

腰腿痛患者报告结局量表的应用分析

目的:检验腰腿痛患者报告结局量表的信度、效度及反应度.方法:2010年8月至2012年1月,纳入住院腰椎间盘突出症及腰椎管狭窄症患者患者200例,男93例,女107例;年龄22～65岁,平均50.3岁;腰椎间盘突出症144例,腰椎管狭窄症56例 应用腰腿痛患者报告结局量表对患者进行测评,并对量表进行信度、效度、反应度分析.结果:39例病情无变化患者两次评分无显著性差异(P＞0.05),且有显著相关性(r＞0.9);该量表同Oswestry功能障碍指数问卷(ODI)对患者评分结果具有显著相关性(r＞0.8);该量表总体克朗巴赫α系数为0.931,总体Guttman折半系数为0.912;该量表KMO统计量为0.919,Bartlett球形检验卡方值l 882.975(P＜0.01),因子分析方法提取特征根值＞1的3个公因子,累计贡献率为64.364％;43例病情有好转患者两次评分结果分别为34.80±9.00和28.77±8.73,两者差异有统计学意义(P＜0.01).结论:腰腿痛患者报告结局量表有较好的信度、效度及反应度,可作为腰腿痛患者临床疗效的评价工具.