诊断性治疗试验的意义:皮肤结核对治疗产生反应需要多久?

Background: It is difficult to demonstrate Mycobacterium tuberculosis in smears or biopsies and to grow it in culture in cutaneous tuberculosis because most cases are paucibacillary. A therapeutic trial of antitubercular drugs is frequently used to confirm the diagnosis in difficult cases. Information is lacking on the response to antitubercular therapy in cutaneous tuberculosis; consequently there are no clear guidelines on when to expect a response and also when to abandon a therapeutic trial. Methods: We studied the records of 60 patients treated for cutaneous tuberculosis at our hospital to study the time course of the therapeutic response. All patients were treated with a short-course antitubercular regimen consisting of isoniazid 300 mg daily, rifampicin 450 mg daily, ethambutol 800 mg daily and pyrazinamide 1500 mg daily for 2 months followed by isoniazid and rifampicin in the same doses for 4 months. At follow-up visits, each patient was assessed by a dermatologist who recorded the presence or absence of clinical improvement in the skin lesions. Results: Of the 60 patients seen, eight patients did not follow up after the initial consultation, 48 patients improved with treatment and four patients were classified as treatment failures. The timing of the first visit varied from 3 days to 15 months (median 27.5 days, mean 58.96 ± .94.50) after initiation of treatment. Twenty-one patients were recorded to have improved within the first month of therapy. Twenty- seven patients who first reported more than 30 days after initiation of treatment were found to have improved. Four patients failed to respond during follow up ranging from 3 to 17 months. Conclusion: When a therapeutic trial is undertaken in cutaneous tuberculosis,6 weeks of therapy with four drugs appears adequate to prove (or disprove) the diagnosis.

酒渣鼻和化妆品及外用药剂引起的接触性变态反应——回顾性分析了1995/2002年的多中心监测资料

The role of contact allergy in rosacea has rarely been investigated. In this retrospective study, 361 out of 76 697 patients tested and documented by the Information Network of Departments of Dermatology between 1995 and 2002 had rosacea. Patch tests included standard series and constituents of cosmetics and topical medicaments. 118/361 had additionally been patch tested with their own cosmetics/medicaments. Positive reactions occurred to nickel (II) sulfate in 9.3% , fragrance mix in 8.8% , thimerosal in 6.9% , Myroxylon pereirae resin in 5.9% , potassium dichromate in 4.6% and propolis in 2.8% . Whereas rosacea patients had a significantly high er risk of contactallergy to propolis compared to the remaining patients, in an age- and sex- adjustedanalysis,contactallergy to nickel was significantly less frequent in this group. For Lyral., the risk was elevated, albeit not significantly. Only 2/329 patients were positive to neomycin sulfate and 1/100 to gentamicin sulfate, among the panel of (topical) antibiotics tested. Among 118 patients tested with their own products, 3 were tested to metronidazole, 1 reacting positively. Irritant or doubtful patch test reactions were provoked by various substances (vehicles, oxidants and preservatives of various creams), which might also be clinically important, considering the heightened sensitivity of rosaceous skin.

聚乙二醇脂质体阿霉素颈外动脉靶向灌注和长效聚乙二醇α干扰素皮损内注射治疗头皮血管肉瘤

Angiosarcoma of the scalp is a rare but highly aggressive malignant tumor that differentiates toward vascular endothelial cells and shows a tendency for diffuse, often clinically occult spread. A 65- year-old Caucasian man presented with multiple erythematous skin lesions at the right scalp hemisphere and a prominent forehead edema that had developed during a period of 2 months. The clinical diagnosis of angiosarcoma was confirmed by histopathology. Because of the advanced local progression of the tumor and the unilateral localization on the right side of the scalp, we initiated an intra-arterial chemotherapy using pegylated liposomal doxorubicin (Caelyx) (8 mg/cycle every 4 weeks by an A. carotis externa port system). In addition, the patient received pegylated interferon alfa (50 μ g/wk) by a percutaneous intralesional injection route. After 2 months, the tumor showed a marked regression; after 4 months, only one nodule located at the margins of the area perfused by the A. carotis externa persisted but regressed after focal irradiation. At 30 months after diagnosis, the patient shows no recurrence of tumor growth. In combination with intralesional interferon alfa, intra- arterial doxorubicin may be a promising innovative therapeutic option for localized scalp angiosarcoma, a hitherto poorly manageable and aggressive malignant tumor.

Fondaparinux作为引起迟发型过敏反应的肝素及半合成肝素样物质的合适代替品7例研究

Hypersensitivity to unfractionated and low-molecular-weight heparins and semisynthetic heparinoids is increasingly common. 7 female patients between 30 and 74 years with delayed-type allergy to heparins and semisynthetic heparinoids were investigated for (cross)-reactivity to fondaparinux, a new pentasaccharide with selective factor Xa inhibition. All patients showed delayed-type reactions to heparins and some additional cross-reaction to a heparinoid on intracutaneous testing. 6/7 tolerated fondaparinux on intradermal testing as well as on subcutaneous challenge testing. However, the 7th patient developed a characteristic delayed-type reaction to both skin tests with fondaparinux. Fondaparinux is a new synthetic pentasaccharide with a molecular weight of 1.728 Da. In some patients with cross-reactivity between various heparins and semisynthetic heparinoids, lepirudin, a recombinant hirudin, may be a safe and effective alternative. However, combined allergy to hirudin and heparins has been reported. Sometimes, intravenous administration of heparins or heparinoids may be tolerated. However, these patients are at risk of developing a systemic reaction. The pathogenesis of heparin hypersensitivity is not fully understood, Heparins may act as haptens by binding to dermal and/or subcutaneous structural proteins. The chemical structures of heparins and fondaparinux are different concerning their α-and β-configuration and the molecular weight. However, some of their functional groups are nearly identical and therefore similar chemical and pharmacological reactivity, is to be expected. Fondaparinux seems to be a valuable alternative in most cases of heparin and hirudin hypersensitivity. The clearly rare cross-reaction between fondaparinux and heparins, now confirmed by us, may be due to differences in the response to haptens.

伴抗磷脂综合征的大疱性系统性红斑狼疮

We report the case of a 44-year-old male with a 10-year history of manifestations of the rare form of bullous systemic lupus erythematosus (SLE) with coexisting antiphospholipid syndrome (APS) that remained undiagnosed until thromboticembolic episodes appeared and high titres of anticardiolipin (ACL) antibodies were detected.The patient fulfilled the criteria for SLE and the atypical cutaneous manifestations together with histopathological changes and a favourable response to sulphones were the grounds for the diagnosis of the bullous variety of SLE.Treatment with prednisolone, acenocoumarol and dapsone resulted in marked clinical improvement, reduction in antinuclear antibodies (ANAs) and normalization of ACL antibody titres.

尼日利亚西北部门诊患者不同皮肤病的流行情况

Background. Information on skin diseases in north-western Nigeria is scanty. We therefore conducted a prospective survey of 2611 new patients seen between August 1999 and July 2001 at the consultant medical/dermatology clinics of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Methods. The personal bio-data of all consecutive patients with skin diseases were documented. They were examined and the diagnoses, which were based on the history of presentation and physical examination, were recorded. Bacteriologic, mycologic, and histologic confirmations were obtained as appropriate. Results. Seven hundred and forty-six patients (28.6% ) had skin diseases. There were 407 male and 339 female patients aged between 0.17 and 90 years; the median age was 27 years. The median ages for male and female patients were 28 and 25 years, respectively. There were 900 skin diseases seen in the 746 patients. The majority of skin diseases were found amongst the youngeragegroup,whichrepresentedover85% ofthepatients. Infectious and parasitic skin diseases accounted for 44.4% of cases; eczema, acne, papulosquamous, and pigmentary skin disorders were observed in 14.1% , 7.0% , 6.4% , and 6.0% of cases, respectively. Conclusions. Preventable skin diseases are common in north- western Nigeria and predominantly affect individuals in the highly productive age group. Health education is therefore necessary to curb their spread, reduce the associated morbidity, and improve the health status of the population. A concerted effort should be made to train health workers in the diagnosis and treatment of the more common dermatologic conditions.

皮肤黑热病后受损的T细胞亚群

Background. The pathogenesis of post- kala-azar dermal leishmaniasis (PKDL) is ill understood.This study was carried out to find the percentage of T- helper and T-suppressor cells in lesional tissue and their probable role in the pathogenesis of PKDL. Methods. An immunoperoxidase monoclonal antibody technique was used to characterize and quantify the subsets of T lymphocytes in the infiltrate in 25 patients with PKDL. Results. The ratio of T-helper to T- suppressor cells was 0.87 in hypopigmented macules and 0.85 in nodule and/or plaque lesions of PKDL. Conclusions. In this study, there was a definite preponderance of T-suppressor cells over T-helper cells in both types of skin lesions of PKDL. Further studies should be undertaken on larger numbers of patients to compare T- cell subsets both in skin lesions and the circulation, in order to determine the pathogenesis of PKDL.

单侧痣样毛细血管扩张综合征

We report on a 29-year-old patient with a unilateral nevoid telangiectasia syndrome (UNTS). Based on microcirculation examinations,both functional impairments at the blood vessel level (laser-Doppler flowmetry) and morphologically altered capillaries (capillary microscopy) could be observed. We could demonstrate that microcirculatory examinations are suitable to demonstrate pathophysiological defects at the vascular level,especially since subclinical functional defects can also be recorded. To our knowledge,no such observations have yet been published with regards to UNTS.