与结核相关的脂膜炎研究进展

【摘要】 脂膜炎病因繁多而复杂,感染为重要病因之一,在欧美等结核低发区,以链球菌感染最为常见,但在结核高发地区如我国,结核杆菌感染是脂膜炎的重要因素,以Bazin硬红斑和结节性红斑最为常见。Bazin硬红斑与结核关系最为密切,常表现为下肢屈侧结节、斑块,可出现溃疡,病理表现为小叶性脂膜炎。结节性红斑可作为结核的早期症状出现,可作为结核的预测指标,常表现为双下肢伸侧红斑、结节,极少破溃,间隔性脂膜炎是其病理特征。Bazin硬红斑和结节性红斑的抗结核治疗常可取得理想效果。因此,明确结核分支杆菌与脂膜炎的关系,在脂膜炎的治疗及预后方面,尤其在结核高发地区有着重要意义。     

Mycobacterium tuberculosis found at both skin lesions and Mantoux testing site in a patient with erythema induratum of Bazin

Mycobacterium tuberculosis is very rarely found in erythema induratum of Bazin; recently, we found an unusual case with positive acid‐fast bacilli and polymerase chain reaction for detecting M. tuberculosis in both skin lesions of the extremities and the site of Mantoux test.     

Erythema induratum of Bazin in an infant after Bacille Calmette-Guerin vaccination

We report the first case of erythema induratum of Bazin (EIB) after Bacille Calmette-Guerin (BCG) vaccination in an infant. The patient developed recurrent multiple erythematous and subcutaneous nodules on his legs 2 months after a BCG vaccination. He had no other symptoms or family history of tuberculosis (TB). Histopathological findings revealed a granulomatous lobular panniculitis. EIB often appears as a chronic, nodular eruptions that frequently occur on the lower legs of females with tuberculin hypersensitivity. To date, only a few cases of infants with EIB have been reported. There have been no clinical reports of EIB after BCG vaccination. Our case suggests that Mycobacterium bovis in the BCG vaccination may have caused EIB.     

试论九十年代中国纪实性电影的电影形态

文章将巴赞的纪实理论作为讨论的起点 ,旨在阐述其所确立的纪实性电影美学的美学特征 ,并以之为参照 ,分析九十年代中国纪实电影的新的电影形态。巴赞纪实理论的基础在于他尊重事物本身的纪实观 ,《民警故事》、《小武》和《过年回家》这三部中国纪实电影的代表作都继承了这种纪实观 ,并具体表现在影片的影像和叙事结构上。通过审视该美学在九十年代中国电影创作中的独特面貌 ,可以发现中国电影人对这个曾被巴赞誉为具有深刻审美性而至今不衰的美学原则所做出的努力和尝试     

Zum Tuberkulid-Begriff aus heutiger Sicht

Zusammenfassung Der Tuberkulidbegriff wurde 1896 von Darier eingeführt. Damit sollten von „echten“ Hauttuberkulosen symmetrische nichtkontagi?se Hauterkrankungen abgegrenzt werden, die Tuberkulose-assoziiert bei hyperergischer Reaktionslage des Organismus als Antwort auf eine h?matogene Streuung von Tuberkelbakterien oder deren Bestandteile entstanden waren. Ein stark positiver intrakutaner Tuberkulintest (Tuberkulinverdünnung 10 ⁻⁹ bis 10 ⁻¹¹ ), eine durchgemachte oder noch manifeste Tuberkulose sowie das therapeutische Ansprechen auf Tuberkulostatika bei nicht m?glichem histologischen oder kulturellen Nachweis von M. tuberculosis in den Hautver?nderungen und ebenfalls die Beobachtung tuberkulidartiger Hauterscheinungen nach BCG-Impfung stützen dieses Konzept. Dem h?ufig hohen Anteil zirkulierender, PPD-spezifischer T-Lymphozyten wird eine besondere Rolle zugesprochen. Das pathogenetische Tuberkulidkonzept wurde auch auf andere infektionsallergische Hautreaktionen übertragen (Mykid, Bakterid, Virusid). „Id-Reaktionen”?u?ern sich meist als nod?se oder multiforme Erytheme, sowie als dyshidrosiforme, lichenoide oder papulo-nekrotische Exantheme. Als gesicherte Tuberkulide gelten Lichen scrophulosorum, papulo-nekrotisches Tuberkulid und Erythema induratum Bazin. Die Variationsbreite von klinischem und histologischem Bild, die wieder wachsende Zahl kasuistischer Beobachtungen sowie neuere immunologische und molekularbiologische Untersuchungsm?glichkeiten haben die Forschung über das Wesen von Tuberkuliden erneut in Gang gebracht. Eingegangen am 14. Juni 1994 Angenommen am 14. September 1994     

Erythema induratum of bazin

Erythema induratum of Bazin is a chronic, nodular eruption that usually occurs on the lower legs of young women. It has been regarded as a manifestation of tuberculin hypersensitivity, a type of tuberculid occurring on the legs, whereas nodular vasculitis represents the nontuberculous counterpart. The number of reports of erythema induratum of Bazin is decreasing in most developed countries in accordance with the decreased incidence of tuberculosis. The etiopathogenesis of erythema induratum of Bazin and its relation to tuberculosis are still controversial, because mycobacteria cannot be cultured from the skin lesions. Most authors currently consider erythema induratum of Bazin (nodular vasculitis) a multifactorial disorder with many different causes, tuberculosis being one of them.     

Erythema induratum of Bazin and Poncet''s disease – successful treatment with antitubercular drugs

Erythema induratum of Bazin (EIB) is considered a tuberculide reaction and consists of recurrent painful nodules predominantly on the calves. Clinically it has common features with diseases like nodular vasculitis, perniosis, polyarteritis nodosa and erythema nodosum. Poncet's disease is a reactive arthritis that may accompany tuberculosis. We report a case of a young woman in which the simultaneous occurrence of erythema induratum of Bazin and Poncet's disease led to a clinical picture very similar to Löfgren's syndrome. The final diagnosis was obtained by polymerase chain reaction detection of mycobacterial DNA in a skin biopsy. A systemic therapy with tuberculostatic drugs led to the disappearance of symptoms. The presented case shows the usefulness of polymerase chain reaction diagnostics in EIB patients without other clinical signs of tuberculosis and a confusing combination of symptoms, and further confirms the presence of mycobacterial DNA in EIB lesions.     

Clofazimine-induced enteropathy in treatment-resistant nodular vasculitis

We report a chronic case of nodular vasculitis that responded to oral clofazimine 300 mg daily. The condition had previously responded to moderate dose oral prednisolone, 50 mg daily, but would recur with weaning. Multiple corticosteroid-sparing agents were trialled, however these were either ineffective or poorly tolerated. The introduction of clofazimine enabled prednisolone dose reduction, not achieved with other agents, to 22.5 mg daily, and was associated with complete suppression of disease activity. Unfortunately the patient developed a clofazimine-induced enteropathy and the treatment was ceased after almost 2 years of therapy. Cessation of clofazimine was associated with a flare of the condition. Clofazimine should be considered as a corticosteroid-sparing agent in resistant cases of nodular vasculitis. Clinicians should be aware of clofazimine-induced enteropathy as a potentially serious complication of the therapy.