皮肤镜在头癣诊治中的应用及其进展

头癣是一种真菌感染性疾病,多发于儿童,根据其临床表现可分为黄癣、白癣、黑点癣、脓癣等。主要表现为局灶性鳞屑斑或脱发,易误诊,常需与其他病因所致的头皮鳞屑或脱发性疾病相鉴别。皮肤镜是一种良好的实时、在体成像技术。头癣在皮肤镜下有其特征性的表现,如逗号发、螺旋状发、Z型发、条形码样发等。该文将对皮肤镜在头癣中的应用进行综述。     

皮肤镜诊断脂溢性角化病与基底细胞癌的准确性及结果分析

目的:探讨皮肤镜诊断脂溢性角化病与基底细胞癌的准确性,参照现有诊断标准对结果进行分析。方法:收集临床诊断为脂溢性角化病和基底细胞癌的病例,参照目前的皮肤镜诊断标准对其作出诊断,并与组织病理结果相比较,分析皮肤镜诊断脂溢性角化病与基底细胞癌的价值,并分析脂溢性角化病和基底细胞癌的皮肤镜特征。结果:应用皮肤镜诊断脂溢性角化病的准确性为94.6%,灵敏度为95.8%,漏诊率为4.2%,特异性为90.0%,误诊率为10.0%,阳性预测值为97.2%,阴性预测值为85.7%。Kappa值为0.843,皮肤镜诊断与病理诊断有极佳的一致性(u=8.901,P0.001)。脂溢性角化病患者中出现频次较高的皮肤镜特征分别为乳黄色角栓或多发性粟丘疹样囊性结构(66.7%)、粉刺样开口(56.5%),其次是沟壑样结构(脑回样外观)(42.0%)。应用皮肤镜诊断基底细胞癌的准确性为83.3%,灵敏度为84.6%,漏诊率为15.4%,特异性为80.0%,误诊率为20.0%,阳性预测值为91.7%,阴性预测值为66.7%。Kappa值为0.609,皮肤镜诊断与病理诊断有高度的一致性(u=3.684,P0.001)。基底细胞癌患者中出现频次较高的皮肤镜特征分别为大的蓝灰色卵圆形巢(81.8%)、多发性蓝灰色小球(59.1%),然后是分支状毛细血管扩张(45.5%)。结论:皮肤镜是一种无创的可以显著提高脂溢性角化病与基底细胞癌确诊率的检查办法,但现有诊断标准还需不断改良和细化。     

兽医中药在宠物临床上的应用

本文系统综述了我国兽医中药在宠物临床上的应用历史及概况。从兽医中药起源,到中药在宠物临床上的古今应用。重点针对宠物临床中常见病、多发病如犬猫皮肤寄生虫病、皮肤真菌病、胃肠道疾病、传染病、肝胆疾病、心肺疾病、腰病以及虚弱性疾病等等进行了归纳总结。同时指出,随着宠物饲养社会功能的变化,宠物中药将会伴随着宠物市场的扩大迎来更大的发展空间。     

输尿管镜超声气压弹道碎石手术的护理配合

输尿管镜手术是经尿道将输尿管镜置入膀胱、输尿管腔内进行诊断和治疗的新技术,可对输尿管进行检查、碎石、取石,可用于治疗输尿管结石、异物、输尿管狭窄等。具有无切口、创伤小、痛苦少、疗效高、时间短及无热效应等优点,是治疗中、下段输尿管结石的首选方法。     

血管镜及内支撑技术在血管损伤中的应用

血管镜可直视观察血管腔内情况,在血管损伤中在帮助术前明确诊断,术中监控手术操作,作后评价手术疗效。它可以血管造影术无法确诊的内膜损伤出直视诊断,在血管镜直视下可行内膜片切除固定、内膜修补血栓切除,局部溶栓等治疗,原位大隐     

角蛋白酶在真菌侵染皮肤过程中的作用

具有高度交联三维结构的角蛋白对各种物理、化学和一般性的蛋白水解酶攻击具有很强的抗性,但在底物的诱导下,皮肤真菌分泌的用蛋白酶可特异性地水解该蛋白。在真菌感染皮肤过程中,用蛋白酶与菌丝的机械侵入和化学还原作用配合,使病原菌获得营养和侵入皮肤。在抗真菌药物的配方中,加入角蛋白酶,可帮助活性因子通过皮肤屏障或抑制病原菌繁殖。     

透明帽辅助结肠镜单人操作在老年患者检查中的临床应用

目的:探讨透明帽辅助结肠镜单人操作在老年患者检查中的临床应用.方法:对2009年8月至12月来我院消化内镜中心进行检查的408例年龄大于60岁的患者,随机分成A组(204例)和B组(204例),全部检查均在非麻醉状态下操作.A组予以透明帽辅助结肠镜检查,B组行常规结肠镜检查.对两种方法的成功率、平均插镜时间、平均疼痛评分、息肉检出率等指标进行比较.针对性别、年龄、腹部或盆腔手术史、长期便秘、肠道憩室等指标分析插镜时间的影响因素.结果:A组和B组结肠镜检查的成功率分别为99.1%和98.5%.平均插镜时间分别为6.4 min和10.8 min(P＜0.05).平均疼痛分数分别为5.8分和5.1分.息肉检出率分别为70.6%和49.5%(P＜0.05).全部检查无并发症发生.在插镜时间的影响因素中,女性、年龄＞80岁、腹部或盆腔手术史、长期便秘等因素有显著差异(P＜0.05).结论:透明帽辅助结肠镜单人操作对于老年患者是一种安全、插镜时间较短、息肉检出率较高的检查方法,年龄超过80岁的老年女性、有腹部或盆腔手术史、长期便秘是导致插镜时间延长的相关因素.     

亚热带地区部队皮肤真菌病及其病原菌的调查研究

亚热带地区是皮肤真菌病的高发地区,据报道,云南边防某部皮肤真菌病发病率为57.8％,占皮肤病发病率的第一位,美军在越南战争期间,发生的所有皮肤病中,最常见的是皮肤真菌感染,而且造成了非战斗减员。战争后期,美军把皮肤病的防治作为其疾病防治的重点。因此,我们于1992年10月底对海南地区部队皮肤真菌病的发病情况进行了流行病学凋查,并对皮肤真菌病的病原菌进行了分离鉴定,现报告如下。     

多功能数字化X线机应用于肠系膜动脉造影诊断小肠出血性病变

影像学检查对小肠病变引起的出血较为困难,以致往往因延误诊断而失去手术时机。选择性肠系膜动脉造影可显示小肠的血管异常,因此是诊断小肠出血性病变的重要检查方法。但是常由于设备的限制而无法在基层医疗机构开展此项检查。笔者应用一般基层医疗单位都具有装备条件的多功能数字化X线机完成多例小肠出血性疾病的诊断,现介绍于下。     

微流控芯片技术在肺部炎性疾病研究和诊断中的进展

微流控芯片技术是指一种将生物、化学等诸多领域的样品从制备、反应到分离检测等多种操作单元高度集成在一块芯片上的技术,由网络状微通道构成,可以通过流体操控整个系统。相比构建模型的传统方法, 具有便携性、高通量、可模拟在体微环境等优势,在研究疾病的诊断、发病机理研究以及药物筛选等方面有着广阔的应用前景。肺部炎性疾病是临床常见的多发病,通常由于细菌、病毒、真菌感染引起。早期肺炎常缺乏明显的呼吸系统症状且症状多不典型,但病情进展快,难以诊断。近年来,微流控芯片技术已经逐渐用于肺部炎性疾病的研究中。尤其是可以再现人肺泡毛细血管界面 (即活肺的基本功能单元) 的关键结构、功能和机械性质的“芯片肺”模型的应用,很好地在体外呈现了肺泡-毛细血管界面模型的生理相关性。相比细胞和动物模型,这种多功能微实验平台具有非常大的优势。文中针对微流控芯片技术在肺部炎性疾病研究和诊断中的进展进行了综述,旨在为肺部炎性疾病的研究和诊断提供新思路。     

Tinea Unguium: Diagnosis and Treatment in Practice

Onychomycosis is caused by dermatophytes, yeasts or non-dermatophyte molds; when caused by dermatophytes, it is called tinea unguium. The main etiological agents are Trichophyton rubrum and Trichophyton interdigitale. The most frequent types are distal and lateral subungual onychomycosis. Diagnosis usually requires mycological laboratory confirmation. Dermoscopy can be helpful and also biopsy is an excellent diagnostic method in uncommon cases or when mycological test is negative. Treatment must be chosen according to clinical type, number of affected nails and severity. The goal for antifungal therapy is the clearing of clinical signs or mycological cure.     

沈阳地区孢子丝菌病48例临床分析

目的探讨孢子丝菌病的发病原因、特点、诊断及治疗。方法对48例孢子丝菌病病例进行调查分析,全部行真菌学检查,部分行病理检查,采用碘化钾、特比萘芬或以碘化钾为基础的联合治疗。结果48例患者有明确外伤史,蚊虫叮咬病史者占总发病人数66.67%。单纯应用碘化钾或以碘化钾为基础的联合治疗8~12周,治愈率均达100%。结论外伤及昆虫叮咬、动物抓伤为本病的重要致病诱因,单纯应用碘化钾或特比萘芬均可治愈,但联合用药起效更快,效果更好。     

Five cases of zygomycosis.

Combined histological and mycological study of tissue specimens established a proven diagnosis of cutaneous zygomycosis in four patients. All patients had been treated with wide spectrum antibiotics and one patient (liver transplantation) was in addition also treated with cyclosporine. All had acidosis and cutaneous breaks and four had also been treated with systemic corticosteroids. The infecting organisms were Absidia corymbifera (n=2), Rhizopus stolonifer (n=1) and Mucor circinelloides (n=1). Combined treatment with i.v. conventional and liposomal formulations of amphotericin B and surgical treatment lead to a favourable clinical and mycological cure in three patients (A. corymbifera and R. stolonifer infections). One lymphoma patient with suspected Rhizopus pusillus infection of the lungs (presence of hyphae in sputum and positive culture) had an unfavourable outcome. The patient had been treated with wide spectrum antibiotics, corticosteroids and showed severe neutropenia and acidosis. The clinical presentations are outlined, including the outcomes and predisposing factors and focus on the diagnostic procedures, treatment and preventive measures.     

A Case of Relapsed Chromoblastomycosis Due to Fonsecaea monophora: Antifungal Susceptibility and Phylogenetic Analysis

Chromoblastomycosis is a chronic cutaneous and subcutaneous mycosis. The management of this infection continues to be challenging because there is no consensus on the therapeutic regimen. We report here a case of a 69-year-old male patient with cauliflower-like lesions on his left leg and foot. He had already been treated with itraconazole at a dose of 200 mg/day for 5 months, with mycological cure for all the affected areas. However, the lesions relapsed at both sites, and treatment with itraconazole was resumed at the dose previously used. Initially, direct mycological examination, cultural, and microculture slide observation were performed. Afterward, sequencing of the ITS1-5.8S rDNA-ITS2 region of the fungal DNA and evaluation of its susceptibility to antifungal agents alone and in combination were performed. In direct mycological examination, the presence of sclerotic cells was verified, and the fungus was identified as Fonsecaea based on cultural and microscopic examinations. Identification as Fonsecaea monophora was confirmed after sequencing of the ITS region and phylogenetic analysis. The isolate was susceptible to itraconazole and terbinafine. The combinations of amphotericin B and terbinafine and terbinafine and voriconazole were synergistic. The use of drugs for which the causative agent is susceptible to singly or in combination may be an alternative for the treatment of mycosis. Furthermore, the identification of the agent by molecular techniques is important for epidemiological purposes. To the best of our knowledge, this is the first case of relapsed chromoblastomycosis caused by F. monophora in Brazil.     

腹部大手术术后深部真菌感染的临床与真菌学分析

目的探讨腹部大手术术后深部真菌感染的危险因素及诊治措施。方法回顾性分析2006年1月～2009年6月期间我科腹部大手术术后合并深部真菌感染48例患者的临床和真菌学资料。结果 48例真菌感染患者共分离出56株菌株,其中白念珠菌占41.1%,是最主要的致病菌株。患者基础疾病和术后长期、多种广谱抗生素联合使用是深部真菌感染的重要因素。结论深部真菌感染是腹部大手术术后的重要并发症,白念珠菌仍然是主要病原菌。对术后患者深部真菌感染应采取积极预防、及时发现和有效治疗。     

Non–Culture-Based Methods for the Diagnosis of Invasive Candidiasis

Given the limitations of current fungal diagnostics, the use of non–culture-based methods for the diagnosis of invasive candidiasis (IC) is highly warranted. The implementation of molecular diagnostic strategies could permit the timely onset of appropriate therapy and may be expected to pave the way for improved clinical outcome of IC. Polymerase chain reaction (PCR) may have higher sensitivity for the diagnosis of IC than conventional blood cultures. The detection of fungal antigens generally requires a large fungal burden, and the presence of fungus-specific antibodies may not correlate with the underlying diseases. Therefore, the combined mannan and anti-mannan antibody testing is recommended. No single test has been shown convincingly to compensate for all the limitations of culture. Real-time PCR coupled with fungal culture and/or antigen detection will likely be required to significantly ameliorate the diagnostic problems in IC.     

Cultivation of fungi from fecal specimens in cases of antibiotic associated diarrhea (AAD)

The aim of performed examinations was to isolate, identify and determine a drug susceptibility of fungi cultured from faecal specimens submitted for detection of Clostridium difficile in cases of antibiotic-associated diarrhoea (AAD). One hundred samples of diarrhoeic faeces were examined using routine bacteriological methods (isolation and identification of C. difficile), serological test (detection of C. difficile toxins A/B) and mycological methods (isolation, identification and drug susceptibility testing of fungi). Out of twenty seven specimens of diarrhoeic faeces fungal strains were isolated, in 20 samples C. difficile strain and/or C. difficile toxins A/B were detected, in 23 specimens fungal strains, C. difficile strains and/or toxins A/B of this species were present. The most active in vitro agent against cultured fungal strains was nystatin. In conclusion it can be stated, that fungal strains are responsible for some cases of antibiotic-associated diarrhoea. So, mycological diagnostics of faecal samples from patients with diarrhoea after antibiotic therapy is necessary. Cases of diarrhoea with mixed bacterial and fungal aetiology (C. difficile + yeast-like fungus) were observed.     

Malt-yeast extract-sucrose agar, a suitable medium for enumeration and isolation of fungi from silage.

A general medium named malt-yeast extract-sucrose agar (MYSA) containing oxgall was designed. The medium was intended for the enumeration and isolation of molds and yeasts in routine examinations of animal feed stuffs. In this study MYSA was tested as a general medium for mycological examination of silage. The medium was compared with dichloran-rose bengal medium (DRBC) in an examination of more than 500 specimens of big bale grass silage. Selected characteristics of known fungal species commonly isolated from feeds were examined after growth on MYSA and DRBC and on malt extract agar, used as a noninhibitory control medium. MYSA suppressed bacterial growth, without affecting the growth of fungi common in feeds. The fungi growing on MYSA were easily recognized, and the medium seemed to slow radial growth of fungal colonies, which permitted, easy counting. The number of species found was higher on MYSA than on DRBC. When we compared MYSA with DRBC for mycological examination of grass silage samples, MYSA was found to be the medium of choice.     

Onychomycosis in Ceará (Northeast Brazil): epidemiological and laboratory aspects

Knowledge of epidemiological and mycological characteristics of onychomycosis has been noted by many authors as being an important tool for control of these fungal infections. This study seeks to improve knowledge of onychomycosis epidemiology and mycological features. Samples were taken from infected fingernails and toenails of 976 patients undergoing treatment at a respected Dermatology Center in Ceará, Fortaleza, CE, Brazil. Specimens from 512 patients (52%) were positive for onychomycosis. From the culture-positive samples, yeasts of the genus Candida (C. albicans, C. tropicalis, C. krusei, C. parapsilosis) were dominant. The dermatophytes isolated (Trichophyton rubrum, T. tonsurans, T. mentagrophytes var. mentagrophytes) were dominant in 46 patients (12.99%). The mould Fusarium spp. was isolated from 29 patients (8.19%). Yeast of the genus Candida is the main causal factor in onychomycosis in our region. Also, the study showed the importance of performing direct examination and culture in diagnosis of onychomycosis.     

Scedosporium apiospermum external otitis.

We report a case of Scedosporium apiospermum external otitis. The patient was topically treated with miconazole cream and achieved a clinical and mycological cure. The etiology, diagnosis and treatment of external fungal otitis are discussed.