某潜艇部队真菌性皮肤病及相关因素调查分析

目的对某潜艇部队官兵真菌性皮肤病患病情况和相关危险因素进行调查分析,为制定防控措施提供依据。方法于2012年7月对某潜艇部队官兵进行真菌性皮肤病临床检查、现场采样镜检、问卷调查和真菌培养鉴定,对各相关因素与真菌性皮肤病患病之间的关系进行单变量和多变量分析。结果该潜艇部队182名官兵真菌性皮肤病患病率为42.3%。其中足癣55例(30.2%),股癣16例(8.8%),甲癣10例(5.5%)。75份官兵皮肤标本共培养出24株念珠菌和6株毛癣菌。logistic多变量分析结果表明,与官兵真菌性皮肤病患病有统计学意义的相关因素为高年龄(30~48岁)、军官与士官、不经常摄入水果,其比值比(OR值)分别为2.71、3.30和3.48(P0.05)。结论该潜艇部队官兵真菌性皮肤病患病率较高,其中独立危险因素是高年龄、军官与士官、不经常摄入水果。     

Cutaneous and mucosal manifestations of inflammatory bowel diseases

The rheumatological, ophthalmological- and dermatological complications are the most common ones among the extraintestinal manifestations of inflammatory bowel diseases (IBD). The incidence of skin manifestations is estimated to be 15-20% in case of Crohn's disease and 10% in case of ulcerative colitis. The so called specific lesions (perianal fissures, metastatic Crohn's disease), which are part of the skin symptoms associated with IBD, show a intimate connections with the bowel disease itself, as they histologically show granulomatous inflammation with epitheloid cells, similar to the ones seen in the intestines. The reactive lesion (erythema nodosum, pyoderma gangraenosum), that form the second main group of skin changes, can also be found is other systemic diseases, but they are more frequently associated with IBD than the average. Cutaneous manifestations may occur due to malabsorption or drug therapy. Finally, there are dermatoses (epidermolysis bullosa acquisitia, acne fulminans) which have a still questionable connection with IBD. Authors present an overview of the IBD's possible skin and mucosal symptoms and their prognostic significance and they demonstrate some rare common skin manifestations found among the IBD patients of Borsod Country (580 ulcerative colitis, 265 Crohn's disease) in the last 25 years.     

Skin disease in Lambeth. A community study of prevalence and use of medical care.

A community survey of skin disease was carried out in Lambeth, London. A postal questionnaire asking recipients to give details of the presence of skin disease was sent to a stratified sample of 2180 adults; a subsample of 614 persons were interviewed at home and an inspection was made of the exposed parts of their skin. Altogether 92 conditions were identified. These were graded for clinical severity and classified into 13 groups. The overall prevalence of skin disease thought to justify medical care was 22-5%. The most common important condition was eczema with a prevalence of 6-1%. Age, sex, and social class trends in prevalence were found in certain groups of skin disease. Of those with a skin disease thought to justify medical care, only 21% reported having attended their general practitioner in the past six months for a skin complaint. The reported use of medical care and self medication is discussed in relation to the presence of skin disease and other factors.     

Die Situation seltener Hautkrankheiten in Deutschland

In Germany a disease is considered to be "rare" when its prevalence is less than 5:10,000. However, as far as genetic skin diseases are concerned, they are often much more uncommon with a prevalence in the range of 1:100,000. Currently considerable deficits prevail in both diagnosis and treatment of rare skin diseases. Driven by scientific research on rare skin diseases and benefiting from start-up grants of the Federal Ministry for Education and Research (BMBF), the following networks for rare skin diseases were formed: a) epidermolysis bullosa, b) ichthyosis and related keratinisation disorders, c) systemic scleroderma. From a scientific point of view these networks are very successful, they publish in high impact journals and at the same time developed into national centres of reference for the respective disease groups, although formally this status does not exist in Germany. Thus, the 5 year start-up grants considerably improved the clinical care for these three skin disease groups. However, now we are confronted with the threat that the newly formed structures will be difficult to maintain, due to lack of adequate financing. In contrast to France, Germany does not have a "national plan for rare diseases"--probably because the federal structure in Germany is difficult to reconcile with "national plans". In France the situation of clinical care for rare diseases is permanently restructured by the establishment of official national reference centres and by allocation of additional financial means to fulfill these national tasks. In our view, a similar approach is also necessary in Germany.     

The pathogenesis of inflammatory dermatoses, especially psoriasis

The skin contains a variety of cell types and mediators, which together constitute the skin's immune system and play a key role in protecting the human body against dangers from outside. Dysregulation of the skin's immune system, however, frequently occurs and can result in undesirable inflammatory processes in the skin. A typical example of an undesirable inflammation in the skin is the chronic inflammatory skin disease psoriasis. In the pathogenesis of psoriasis, both genetic and environmental factors play a key role. In psoriasis, the complex interactions between T-lymphocytes, antigen-presenting cells, keratinocytes and pro-inflammatory cytokines and chemokines are disturbed. The two most widely accepted hypotheses are: (a) psoriasis is a T-cell mediated autoimmune disease, and (b) psoriasis is the result of a too finely adjusted system for regulating inflammation in the skin. The result of both mechanisms is a chronic inflammatory reaction fuelled by pro-inflammatory type-I cytokines that lead to the psoriasis-skin phenotype. With the development ofbiologicals, it has become feasible to target specific molecules in the immune process, for example type-I cytokines and the molecules present on pathogenic T-cells. This approach has already proved successful in the treatment of rheumatoid arthritis and Crohn's disease, creating novel therapeutic options for psoriasis and other inflammatory dermatoses.     

Skin diseases

Skin diseases are very common and severe in tropical climates. These diseases can be bacterial, parasitic or fungal in nature. Some skin infections can cause systemic failures, general physical discomfort, and social embarrassment. Despite this, developing countries do not give much attention to this problem. Most skin diseases can be diagnosed by careful observation of the position, size, shape, color and nature of the lesions. If observation cannot provide an answer, laboratory diagnosis (microscopy and/or culture of skin scrapings) will. Once a diagnosis is confirmed, the disease may be treated with topical ointments, systemic drugs, or other non-drug remedies. Topical treatments can help any of the major skin infections if the treatment changes with the nature of the lesion. Neomycin, bacitracin, Neosporin, Betadine, gentian violet, lindane and potassium permanganate are a few of the commercially available topical drugs. Severe infections usually calls for systemic medication. Bacterial infections are treated with penicillin and fungal infections are treated with griseofulvin and ketoconazole. Some bacteria have become resistant to certain drugs, so health workers should keep abreast of regional resistances. Non-drug remedies include hot compresses and lancing. Regular bathing and hand washing, clean clothing, and clean linens do much to prevent spreading of the skin disease. Education of communities through leaflets, audiovisual, and simplified textbooks prevent community-wide disease spread. Early detection and treatment also inhibits disease transmission. Government programs that deal with skin diseases and their treatment and prevention would be beneficial to the communities and to the health workers that deal with these problems.     

Behçet's disease in a Dutch boy with painful skin lesions

A 14-years-old Dutch boy had pain in both calves, recurrent oral ulcers, fever, hoarseness and erythema nodosum-like skin lesions. Laryngoscopic examination revealed a vocal cord ulcer and leukocytoclastic vasculitis was visible in a skin biopsy. Based on the clinical picture, the diagnosis of 'incomplete juvenile Beh?et's disease' was established. During treatment with colchicine, genital ulcers developed. These disappeared after local treatment with corticosteroids. Juvenile Beh?et's disease is rare in Western Europe and the diagnosis is often difficult. Diagnostic criteria have been formulated, but in most cases there is a delay before these criteria are fulfilled due to the slow clinical course of the disease. All organ systems may be affected; mucocutaneous and skin lesions are the most frequent manifestations. Therapy depends on the severity and the symptoms of the disease.     

A pseudo-outbreak of skin disease in British troops.

When a newspaper report claimed that a serious outbreak of skin disease had occurred in British Army troops stationed at the Bocac Dam, in western Bosnia, all troops at the Bocac Dam location (n = 96), followed by a matched control group of troops (n = 91) at a nearby location, were examined by two investigators. 14% of the study population and 21% of the control group were found to have skin disorders. Most were complaints that are commonly encountered in general medical practice. There was a striking absence of skin infestations. The historical consultation rate for skin disorders had not increased. It was concluded that an outbreak of skin disease had not occurred in British troops guarding the dam. This epidemiological study shows that, even under conditions of modern field hygiene, up to one in five soldiers will have skin disease. Skin infestations, however, have become progressively less common during military campaigns this century, probably because of better personal hygiene, good preventive medicine practices and better access to effective health care.     

老年人直接喉镜和视可尼喉镜经口气管插管的比较

目的：评价老年人采用视可尼喉镜经口气管插管的有效性和安全性。方法：选取80例全麻手术患者,随机分为视可尼喉镜组（S组）和直接喉镜组（H组）,每组各40例,记录并对比两组不同时点的HR、SBP、DBP,气管插管操作时间、插管次数及并发症情况。结果：视可尼喉镜组（S组）各方面明显优于直接喉镜组（H组）。结论：虽然视可尼喉镜和直接喉镜气管插管对血压和心率都有影响,但与直接喉镜相比,视可尼喉镜对心率影响不大,操作较简单,损伤小,特别适用于牙齿松动,合并高血压、心脏病、颈椎病的老年患者。     

Skin and respiratory symptoms among workers with suspected work-related disease

Background Many workers are exposed to chemicals that can cause both respiratory and skin responses. Although there has been much work on respiratory and skin outcomes individually, there are few published studies examining lung and skin outcomes together. Aims To identify predictors of reporting concurrent skin and respiratory symptoms in a clinical population. Methods Patients with possible work-related skin or respiratory disease were recruited. An interviewer- administered questionnaire collected data on skin and respiratory symptoms, health history, smoking habits, workplace characteristics and occupational exposures. Predictors of concurrent skin and respiratory symptoms were identified using multiple logistic regression models adjusted for age, sex and atopy. Results In total, 204 subjects participated; 46% of the subjects were female and the mean age was 45.4 years (SD = 10.5). Most subjects (n = 167, 82%) had possible work-related skin disease, compared with 37 (18%) subjects with possible work-related respiratory disease. Subjects with a history of eczema (OR 3.68, 95% CI 1.7-7.8), those from larger workplaces (OR 2.82, 95% CI 1.8-7.4) and those reporting respirator use at work (OR 2.44, 95% CI 1.2-4.8) had significantly greater odds of reporting both work-related skin and respiratory symptoms. Current smoking was also associated with reporting concurrent skin and respiratory symptoms (OR 2.57, 95% CI 1.2-5.8). Conclusions Workers reported symptoms in both systems, and this may be under-recognised both in the workplace and the clinic. The association between history of eczema and concurrent skin and respiratory symptoms suggests a role for impaired barrier function but needs further investigation.     

Cutaneous manifestations of strongyloidosis

Strongyloidiasis is a parasitic disease, caused by Strongyloides stercoralis, an intestinal nematode, which is mainly endemic in tropical and subtropical regions. It can be sporadically found in the temperate zone, especially in closed communities and among people living under bad social conditions. Gastrointestinal, pulmonary and cutaneous symptoms may arise during the migration of the larvae. The infections are chronic and poor in symptoms among immunocompetent patients. Sometimes the cutaneous manifestation is the only symptom of the disease besides the distinct eosinophilia. Intense itching, erythematosus papule and petechiae develop at the site of the skin infection. Rapidly progressing linear, serpiginous, urticarial streaks are the pathognomic cutaneous manifestations that are called larva currents. The appearance of erythematosus, linear stripes are due to the migrating larvae in the skin. The most common nonspecific symptoms are urticaria, maculopapular exanthema, localized or generalized pruritus and prurigo. The parasite is uniquely able to carry out its whole life cycle inside the human body, so in immunocompromised patients the disease can lead to a hyperinfection syndrome with high mortality, due to the accelerated endogenous autoinfection. Authors present all possible skin manifestations of the strongyloidiasis, based on the case history of three brothers and sisters and that of a female patient suffering from hyperinfection syndrome.     

Nephrogenic fibrosing dermopathy

A 58-year-old man with renal insufficiency, who was being treated by haemodialysis, developed progressive skin lesions. He had thickening and hardening of the skin at the extremities and swelling of the toes and fingers with flexion contractures. His face was not affected. Laboratory evaluation was unremarkable and a skin biopsy [table: see text] showed an increase of collagen and mucin, without an inflammatory infiltrate. These clinical features resemble a recently reported new disorder: nephrogenic fibrosing dermopathy. This disorder manifests as scleromyxedema-like cutaneous skin lesions without associated paraproteinemia, occurring in the setting of renal disease. The histopathologic features of nephrogenic fibrosing dermopathy, i.e. thickened collagen and mucin deposition, are unique. The incidence, prevalence and cause of the disease are unknown and there is currently no effective treatment. The Centers for Disease Control and Prevention (CDC) in the USA are calling on physicians who have encountered patients suffering from this type of lesions to contact the CDC for an intended control study.     

Fabry's disease; towards a treatment

Fabry's disease, deficiency of the enzyme alpha-galactosidase A, is an X-linked lysosomal storage disorder. Clinical symptoms are caused by continuous deposition of specific glycolipids in endothelial cells, neural cells, skin and cornea. These depositions give rise to skin (angiokeratoma) and eye abnormalities (cornea verticillata), acroparaesthesias and anhidrosis and later in life cause renal insufficiency and cardiovascular complications. Hemizygous males suffer from Fabry's disease, whereas female carriers (heterozygotes) are usually asymptomatic. Recently, an atypical presentation of Fabry's disease was described in males who only presented with cardiac involvement. Therefore, the actual number of Fabry patients in the Netherlands could be higher than the predicted 300. Diagnosis in males can be established by measuring alpha-galactosidase enzyme activity in plasma, leukocytes or fibroblasts. Apart from kidney transplantation only symptomatic therapy is available today. Enzyme supplementation therapy (as shown in Gaucher's disease) and substrate deprivation are possible ways of treatment in the future.     

Mucocutaneous manifestations of amyloidosis

Amyloidosis is the collective term for a group ofuncommon metabolic disorders in which insoluble amyloid protein-fibres are deposited in tissues and organs. Mucocutaneous manifestations are frequently found in this disease. The different types ofamyloidosis are divided into a systemic and a non-systemic group. Systemic amyloidosis is characterised by amyloid deposits in several organs. In the most frequent type, amyloid light chain (AL) systemic amyloidosis, the skin is involved in 29-40% of the cases. These mucocutaneous manifestations are sometimes the first clue to the discovery of systemic involvement. The non-systemic group comprises primarily localised amyloid deposits in skin and mucosa. The treatment of localised mucocutaneous amyloidosis is aimed at the local changes themselves. The mucocutaneous manifestations due to systemic amyloidosis may improve when it is possible to treat the underlying disease successfully.     

Paraneoplastic dermatoses

Paraneoplastic dermatoses are important cutaneous markers of internal malignancies. They form a heterogenous group of skin diseases, where tumor induced immunologic factors, hormones, metabolic disorders and epidermal growth factor may play a role in the onset of the symptoms. The paraneoplastic skin disorder frequently refers to the type, localization and prognosis of the underlying tumor. The course of the tumor and that of the skin disease is generally parallel, which means that the cutaneous symptoms disappear when the tumor is treated and reappear in case of recurrence or metastasis. Seven rare obligate paraneoplastic dermatoses are known, where the skin marker is associated with neoplasia in almost 100% of the cases. The facultative paraneoplastic dermatoses are more common skin disorders, with a wider spectrum, and they are only associated with tumors in 3-30% of the cases. Authors present an overview of the clinical characteristics, etiopathogenesis and the underlying tumor of the most important paraneoplastic dermatoses.     

Cutaneous symptoms of zinc deficiency in adults

Malabsorption is frequently accompanied by skin symptoms, which are the most likely first manifestation of the disease. Skin lesions are mainly due to the deficiency of zinc, different vitamins, minerals, essential aminoacids, and other nutrients. The present paper demonstrates 3 patients with different types of skin symptoms primarily related to zinc deficiency, which occur in gastrointestinal diseases and alcohol abuse (acrodermatitis enteropathica, eczema craquele, hyperpigmentation).