罗扎诺夫论陀思妥耶夫斯基:关于“瘙痒”的“神言”

罗扎诺夫写过许多关于陀思妥耶夫斯基的文章,他认为,陀思妥耶夫斯基有一个卓越的想法,幸福对于每个人来说就是实现自己的愿望,而全部问题就在于"瘙痒",因为每个人都以自己的方式"瘙痒"。其实,罗扎诺夫还有一个更为出色的观念。他认为陀思妥耶夫斯基的全部作品中有那么七八十页堪称"神言"的巅峰之作,它们以独特的方式所达到的那种威力、美丽、光辉,那种深入"事物本质"的穿透力,是其他作家那里从未碰到过的。那么,"瘙痒"与"神言"之间究竟是怎样的关系?据罗扎诺夫的意见,只有先知才能真正理解瘙痒的意义,只有执著于瘙痒的人,才有可能说出"神言"。罗扎诺夫本人是理解"瘙痒"的,并且在《隐居》《落叶》等著作中说出了自己的"神言"。

Albumin liver dialysis as pregnancy-saving procedure in cholestatic liver disease and intractable pruritus

Progressive familial intrahepatic cholestasis type 3 (PFIC3) is a rare cholestatic liver disease. Such liver disease can get worse by female hormone disorder. Albumin dialysis or Molecular Adsorbent Recirculating System (MARS) has been reported to reverse severe cholestasis-linked pruritus. Here, we report the first use of MARS during a spontaneous pregnancy and its successful outcome in a patient with PFIC3 and intractable pruritus. Albumin dialysis could be considered as a pregnancy-saving procedure in pregnant women with severe cholestasis and refractory pruritus.

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by maternal pruritus in the third trimester, raised serum bile acids and increased rates of adverse fetal outcomes. The etiology of ICP is complex and not fully understood, but it is likely to result from the cholestatic effects of reproductive hormones and their metabolites in genetically susceptible women. Equally unclear are the mechanisms by which the fetal complications occur. This article reviews the epidemiology, clinical features, diagnosis, etiology and management of ICP.

Recent advances in the management of pruritus in chronic liver diseases

Pruritus is a symptom found in patients with chronic liver diseases,especially cholestatic liver diseases such as primary biliary cholangitis.This symptom impairs patient quality of life by disturbing sleep and may lead to consideration of liver transplantation.Mechanisms implicated in pruritus have been associated with the peripheral and central nervous systems,leading to the development of various therapeutic options.Little evidence for the efficacy of most of these treatments is currently available,indicating a need for further investigations.

How we can improve patients’comfort after Milligan- Morgan open haemorrhoidectomy

AIM:To demonstrate the value of Diosmin(flavonidic fraction)in the management of post-haemorhoidectomic symptoms.METHODS:Eighty-six consecutive patients with grades ⅢandⅣacute mixed hemorrhoids admitted to the Anorectal Surgical Department of First Affiliated Hospital,Xinjiang Medical University from April 2009 to April 2010,were enrolled in this study.An observerblinded,randomized trial was conducted to compare post-haemorhoidectomic symptoms with use of Diosmin flavonidic fraction vs placebo.Eighty-six patients were randomly allocated to receive Diosmin flavonidic fraction 500 mg for 1 wk(n=43)or placebo(n=43).The Milligan-Morgan open haemorrhoidectomy was performed by a standardized diathermy excision method.Pain,bleeding,heaviness,pruritus,wound edema and mucosal discharge were observed after surgery.The postoperative symptoms and hospitalization time were recorded.RESULTS:The mean age of the Diosmin group and controls was 53.2 and 51.3 years,respectively.In Diosmin group,haemorrhoid piles were of the third degree in 33 patients and the fourth degree in 10;and in the control group,29 were of the third degree and 14 were of the fourth degree.There was no statistically significance in age,gender distribution,degree and number of excised haemorrhoid piles,and the mean duration of haemorrhoidal disease between the two groups.There was a statistically significant improvement in pain,heaviness,bleeding,pruritus from baseline to the 8th week after operation(P<0.05).Patients taking Diosmin had a shorter hospitalization stay after surgery(P< 0.05).There was also a significant improvement on the proctoscopic appearance(P<0.001).However,there was no statistical difference between the two groups in terms of wound mucosal discharge.Two patients experienced minor bleeding at the 8th week in Diosmin group,and underwent surgery.CONCLUSION:Diosmin is effective in alleviating postoperational symptoms of haemorrhoids.Therefore,it should be considered for the initial treatment after haemorrhoid surgery.However,further prospective randomized trials are needed to confirm the findings of this study.

Hypertrophied anal papillae and fibrous anal polyps,should they be removed during anal fissure surgery?

AIM:Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice. They are mostly ignored being considered as normal structures.The present study was aimed to demonstrate that hypertrophied anal papillae and fibrous anal polyps could cause symptoms to the patients and that they should be removed in treatment of patients with chronic fissure in anus. METHODS:Two groups of patients were studied.A hundred patients were studied in group A in which the associated fibrous polyp or papillae were removed by radio frequency surgical device after a lateral subcutaneous sphincterotomy for relieving the sphincter spasm.Another group of a hundred patients who also had papillae or fibrous polyps,were treated by lateral sphincterotomy alone.They were followed up for one year. RESULTS:Eighty-nine percent patients from group A expressed their satisfaction with the treatment in comparison to only 64% from group B who underwent sphincterotomy alone with the papillae or anal polyps left untreated.Group A patients showed a marked reduction with regard to pain and irritation during defecation (P=0.0011), pricking or foreign body sensation in the anus (P=0.0006) and pruritus or wetness around the anal verge (P=0.0008). CONCLUSION:Hypertrophied anal papillae and fibrous anal polyps should be removed during treatment of chronic anal fissure.This would add to effectiveness and completeness of the procedure.

Hepatitis C virus-associated pruritus: Etiopathogenesis and therapeutic strategies

In addition to its contributing role in the development of chronic liver diseases, chronic hepatitis C virus (HCV) infection is associated with extrahepatic manifestations, particularly, cutaneous-based disorders including those with pruritus as a symptom. Pruritus is frequently associated with the development of chronic liver diseases such as cholestasis and chronic viral infection, and the accumulation of bile acids in patients&#x02019; sera and tissues as a consequence of liver damage is considered the main cause of pruritus. In addition to their role in dietary lipid absorption, bile acids can trigger the activation of specific receptors, such as the G protein-coupled bile acid receptor (GPBA/ TGR5). These types of receptors are known to play a crucial role in the modulation of the systemic actions of bile acids. TGR5 expression in primary sensory neurons triggers the activation of the transient receptor potential vanilloid 1 (TRPV1) leading to the induction of pruritus by an unknown mechanism. Although the pathologic phenomenon of pruritus is common, there is no uniformly effective therapy available. Understanding the mechanisms regulating the occurrence of pruritus together with the conduction of large-scale clinical and evidence-based studies, may help to create a standard treatment protocol. This review focuses on the etiopathogenesis and treatment strategies of pruritus associated with chronic HCV infection.

Acupuncture Treatment for 34 Cases of Uremic Cutaneous Pruritus

Chronic renal insufficiency is the result of renal injuries and progressive deterioration caused by various reasons. At the late stage, i.e. the period of uremia, it may be complicated with abnormalities of various systems. Along with the development and popularization of hemodialysis, the survival time of uremic patients can be prolonged, but uremic pruritus affects greatly the quality of life of the patients. For this purpose, we have treated 68 cases of the patients with acupuncture and western medicine respectively, and made clinical observations on the therapeutic results. A report follows.……

Twenty-five Cases of Intractable Cutaneous Pruritus Treated by Auricular Acupuncture

Intractable cutaneous pruritus is a commonlyencountered symptom in clinical practice.Theauthors have treated 25 cases of intractable cutaneouspruritus mainly by auricular acupuncture in recentyears,with satisfactory results as reported in thefollowing.Clinical DataAll the 50 cases in this series were outpatientsfrom the Outpatient Department of

Effect of oral naltrexone on pruritus in cholestatic patients

AIM： To determine the efficacy and potential complications of oral naltrexone used in the treatment of pruritus in cholestatic patients and to compare them with other studies.METHODS： Thirty-four enrolled cholestatic patients complaining of pruritus were studied. In the initial phase, pruritus scores during day and night were evaluated. Subsequently, patients were given a placebo for one week followed by naltrexone for one week. In each therapeutic course （placebo or naltrexone） day and night pruritus scores were distinguished by a visual analogue scale （VAS） system and recorded in patients＇ questionnaires.RESULTS： Both naltrexone and placebo decreased VAS scores significantly. Naltrexone was more effective than placebo in decreasing VAS scores. Both day and night scores of pruritus decreased by half of the value prior to therapy in thirteen patients （38%）. Daytime pruritus improved completely in two patients （5.9%）, but no improvement in the nighttime values was observed in any patient. Sixteen patients （47%） suffered from naltrexone complications, eleven （32%） of them were related to its withdrawal. Complications were often mild. In the case of withdrawal, the complication was transient （within the first 24-28 h of therapy） and self-limited. We had to cease the drug in two cases （5.9%） because of severe withdrawal symptoms. CONCLUSION： Naltrexone can be used in the treatment of pruritus in cholestatic patients and is a safe drug showing few, mild and self-limited complications.

Reliability and validity of dermatology life quality index: assessment of quality of life in human immunodeficiency virus/acquired immunodeficiency syndrome patients with pruritic papular eruption

OBJECTIVE: To test the reliability and validity of dermatology life quality index(DLQI) in simplified Chinese language by assessing the quality of life(QoL) in HIV(human immunodeficiency virus)/AIDS(Acquired immunodeficiency syndrome) patients with pruritic papular eruption(PPE). METHODS: A study of simplified-Chinese-versiond from10 questions with the principal component analysis and the contribution rate of the 3 common factors was 59.95%. CONCLUSION: The simplified-Chinese-version DIQL is an acceptable and valid scale for HIV/AIDS patients with PPE. It can be used to evaluate the QoL of HIV/AIDS patients with PPE in China.

Clinical Application of Shousanli (LI 10)

Acupoint Shousanli （LI 10） is also called Shangsanli, Guixie, locates at the radial aspect of the back of the forearm, 2 cun below Quchi （LI 11）, on the line joining Yangxi （LI 5） and Quchi （LI 11）. Shousanli （LI 10） was firstly recorded in Zhen Jiu Jia Yi Jing （A-B Canon of Acupuncture and Moxibustion）. It is widely applied in clinic, and especially acts to dredge meridians and collaterals, promote qi circulation to relieve pain. Now, the clinical applications of Shousanli （LI 10） were summarized as follows.

Unexpected massive cutaneous pruritus treated by acupuncture

This article introduced that during the author’s overseas period, acupuncture was applied at Tàixī （太溪 KI 3）, Sānyīnjiāo （三阴交 SP 6）, Yīnlíngquán （阴陵泉 SP 9）, Zúsānlǐ （足三里 ST 36）, Fēnglóng （丰隆 ST 40） and Xùehǎi （血海 SP 10） to treat massive cutaneous pruritus and satisfactory clinical efficacy was achieved, which indicated acupuncture had positive effect on cutaneous pruritus.

Reduction of serum level of interleukin-2 and pruritus severity after acupuncture at Quchi(LI11)in hemodialysis patients:a placebo-controlled randomized clinical trial

Objective To observe the effect of acupuncture at Quchi(LI11)on the serum interleukin-2(IL-2)level and the severity of uremic pruritus(UP)in hemodialysis patients.Methods Sixty hemodialysis patients with UP were randomized into an acupuncture group and a control group,with 30 cases in each group.In the acupuncture group,patients were treated with acupuncture at Quchi(LI11)twice a week for six weeks.In the control group,each patient received a placebo treatment(sham acupuncture).Before and after the intervention,the pruritis severity was examined using a 5-D scale,and the serum IL-2 level was measured using an enzyme-linked immunosorbent assay kit.Results There were no statistically significant differences in the demographic or clinical factors between the control group and the acupuncture group at baseline.The reduction in pruritus severity in patients was more significant in the acupuncture group(P=0.027).Acupuncture therapy also significantly decreased the serum IL-2 level in the patients(P=0.011).Throughout the acupuncture procedures,the incidence of pain and mild bleeding was 3.6%and 2.5%,respectively.Conclusion Six-week acupuncture treatment at Quchi(LI11)can effectively decrease the severity of UP and the serum IL-2 level.Large-scale,long-duration,and multi-center studies are needed to fully understand the role of IL-2 in inflammation and neuroimmune stimulation during acupuncture.

Examples of Application of Ligou(LR 5)

To study the application and mechanism of Ligou(LR 5)in the treatment of urinary and reproductive system diseases from its location,meridian,application alone and combined application in clinic based on syndrome differentiation,and to guide its application in clinic.

Dopaminergic system does not play a major role in the precipitated cannabinoid withdrawal syndrome

AIM:To determine the dopaminergic system involvement in precipitated cannabinoid withdrawal syndrome.METHODS:The dopamine D_(1)receptor antagonist SCH23390 or the dopamine D_(2)receptor antagonist sulphide was administered to rats chronically treated with either△^(9)-tetrahydrocannabinol(THC)or vehicle.Subjects were then injected with either SR141716A or vehicle and behavior was observed for 1 h.RESULTS:Administration of the cannabinoid receptor antagonist SR141716A to animals chronically treated with THC as described by Tsou et al(1995)produced a profound withdrawal syndrome.Treatment with dopamine antagonists did not attenuate cannabinoid precipitated withdrawal syndrome in THC tolerant animals while the agonists increased the syndrome.CONCLUSION:It is unlikely that the dopaminergic system plays a major role in mediating the behavioral aspects of the cannabinoid withdrawal syndrome.