局部氧疗联合红油膏促进慢性皮肤溃疡的愈合

目的探讨局部氧疗联合红油膏对促进慢性皮肤溃疡愈合的疗效。方法采用方便抽样法选取岳阳中西医结合医院皮肤科2009年12月至2010年12月住院期间的慢性皮肤溃疡患者60例,按随机数字表法将其分为观察组(n=29)和对照组(n=31),观察组患者在外用红油膏治疗基础上结合局部氧疗,对照组患者仅外用红油膏治疗。治疗3周后比较两组患者疮面的细菌培养结果、疗效,并观察不良反应发生情况。结果治疗后两组患者疮面细菌培养结果均较培养前有改善(均P<0.05);观察组患者治疗总有效率为82.75%,高于对照组的48.39%,两组疗效比较差异有统计学意义(P<0.05)。对照组有1例患者用药后发生局部皮肤红斑、瘙痒。结论局部氧疗联合红油膏治疗慢性皮肤溃疡能提高临床疗效,从而促进了慢性皮肤溃疡疮面的愈合。     

盐酸米诺环素软膏瘘管通过术治疗顽固瘘管型根尖周炎

目的 观察盐酸米诺环素软膏瘘管通过术治疗顽固性(瘘管型)根尖周炎的效果.方法 选择顽固性(瘘管型)根尖周炎共40例 (经常规根管预备后用氢氧化钙封药3次瘘管未愈合),其中20例为治疗组,改用盐酸米诺环素软膏瘘管通过术治疗;另20例为对照组,继续用氢氧化钙根管封药,并用2%碘酚烧灼瘘管.结果 治疗组19例(95%)治愈,对照组12例(60%)治愈,2组比较差异有统计学意义(P<0.05).结论 对顽固瘘管型根尖周炎如多次常规根管内封药无好转,改用盐酸米诺环素软膏瘘管通过术治疗效果好.     

四黄膏外敷治疗皮下注射胰岛素所致皮下硬结的疗效观察

目的 观察四黄膏外敷治疗皮下注射胰岛素所致皮下硬结的治疗效果。方法 选取皮下注射胰岛所致皮下硬结的糖尿病患者60例,将60例患者分为治疗组和对照组,每组各30例,治疗组使用四黄膏外敷皮下硬结, 1次/d;对照组使用50%硫酸镁湿敷,3次/d,7 d后进行治疗效果评定。 结果 治疗组治疗效果优于对照组(Z=-3.112,P=0.002)。 结论 四黄膏外敷治疗皮下注射胰岛素所致皮下硬结,皮下硬结明显缩小,局部压痛明显减轻,效果佳,操作方便,患者治疗依从性高,费用低,经济适用。     

Methylprednisolone aceponate in eczema and other inflammatory skin disorders -- a clinical update

Methylprednisolone aceponate (MPA) has been shown to provide rapid, reliable and highly effective treatment of eczematous disorders, with an efficacy comparable to that of most reference topical corticosteroids. It also has excellent local and systemic tolerability. MPA is effective in the treatment of facial and scalp eczema and sunburn and has shown promising results in the treatment of psoriasis. Its rapid efficacy and lack of undesirable local and/or systemic side effects make MPA particularly suitable for use in children and infants. The wide range of formulations (0.1%) of MPA, including cream, ointment, fatty ointment, milk and solution, enable treatment to be tailored to the individual patient. In addition, MPA has the advantage of once-daily application compared with twice-daily treatment for other topical corticosteroids, thereby improving patient safety and promoting patient compliance but without compromising efficacy.     

Use of deception to achieve double-blinding in a clinical trial of Melaleuca alternifolia (tea tree) oil for the treatment of recurrent herpes labialis

Double-blinding is an important and widely implemented feature of clinical trials although its success is rarely assessed. In a randomized, placebo-controlled trial of tea tree oil, an aromatic essential oil, for the treatment of recurrent herpes labialis (RHL), or cold sores, deception was used to prevent volunteers from identifying their treatment allocation. Volunteers received placebo (n=102) or tea tree oil (n=112) ointment in preparation for their next episode of RHL and were told, falsely, that the aroma of the ointments had been changed to prevent identification of the treatment group. At the trial's end, of the volunteers who had used their ointment and presented for treatment assessment (n=100), approximately 50% correctly guessed their treatment allocation (P=0.774). Amongst volunteers that had not presented for treatment assessment (n=114), 12 volunteers did not provide blinding data and 46 did not open their tube. For the 56 volunteers who opened their tube, less than half of those receiving tea tree oil (44.4%) and only a small proportion of those on placebo (17.2%) were able to correctly identify their treatment allocation. Among the volunteers that were not treated, the P-value was 0.083. This study showed that the ethical use of deception may provide effective blinding in challenging circumstances.     

喜疗妥软膏联合远红外线照护对血液透析患者自体动静脉内瘘功能影响的研究

目的探讨喜疗妥软膏联合远红外线照护对血液透析的患者自体动静脉内瘘功能的影响。方法将180例采用自体动静脉内瘘进行长期血液透析患者随机分为对照组和观察组,每组90例,对照组采用局部喜疗妥软膏外涂,观察组采用局部喜疗妥外涂联合远红外线照护。比较两组患者治疗3个月后血管情况。结果观察组患者治疗3个月后,在改善内瘘血管弹性、提高血液透析患者自体动静脉内瘘透析时的血流量等方面均优于对照组,两组比较差异有显著意义（P〈0．05）。结论血液透析患者自体动静脉内瘘护理,局部用喜疗妥外涂联合远红外线照护,效果优于局部单纯用喜疗妥外涂。     

An evaluation of the use of propolis in the treatment of skin disorders on the stumps of patients in rehabilitation following lower limb limb amputation

Background. Skin disorders on the stumps of patients with lower limb amputations constitute a hindrance, even a major obstacle to installing and wearing prostheses. This is turn disorganizes the patient's return to normal activity and reduces his quality of life. Treatment of these disorders is difficult and often requires much time. The use of propolis as the treatment method of choice in skin disorders and deficits on post-amputation stumps is suggested by its antibacterial, analgesic, and regenerative action on affected tissues. Material and methods. Our research covered 156 lower limb amputees, including 55 upper leg amputees (group A) and 101 lower leg amputees (group B). Those patients qualified for treatment received 4% propolis ointment applied to the wound twice daily for 7 days: in the absence of satisfactory results, treatment was prolonged to 14 days. Outcome was evaluated by observation, clinical history, and a 4-point outcome scale. Results. Group A showed somewhat better outcome than group B. The best results in both groups were obtained by patients with staphylococcus infections. Propolis ointment acting locally on the skin improved circulation, stimulates intracellular metabolism and changes the reactivity of the skin. Propolis ointment is both mild and effective. No complications were observed. Conclusions. Propolis ointment can be used more widely in the treatment of local disturbances of trophicity, as well as skin disorders and deficits on stumps. Better results are obtained when there is adequate blood supply to the place of treatment.     

自拟化管生肌膏治疗低位单纯性肛瘘术后创面的效果

目的观察自拟化管生肌膏治疗低位单纯性肛瘘术后创面的效果。方法将50例低位单纯性肛瘘患者按随机原则分为治疗组和对照组,各25例。治疗组术后用自拟化管生肌膏换药,对照组术后用生肌玉红膏换药。比较两组的治疗效果。结果治疗组的创面愈合时间、渗液时间显著短于对照组(P<0.05)。术后7、14、21 d,治疗组的创面愈合率显著高于对照组(P<0.05)。术后14、21 d,治疗组的创面分泌物评分均显著低于对照组(P<0.05)。术后21 d,治疗组的创面分泌物pH高于对照组,肉芽评分、VAS评分低于对照组(P<0.05)。结论自拟化管生肌膏治疗低位单纯性肛瘘术后创面有加速愈合、缩短住院时间、减轻患者局部疼痛等优势。     

复方炉甘石洗剂与氧化锌软膏治疗过敏性皮炎的疗效比较

目的对比复方炉甘石洗剂与氧化锌软膏治疗过敏性皮炎的疗效。方法将82例过敏性皮炎患者随机分为治疗组和对照组,每组41例。治疗组采用复方炉甘石洗剂治疗,对照组采用氧化锌软膏治疗。观察2组临床疗效及不良反应发生情况。结果治疗组总有效率为97.56%,高于对照组87.80%,但差异无统计学意义(P>0.05)。2组患者在治疗期间均未出现皮肤过敏、全身不适等不良反应。结论复方炉甘石洗剂与氧化锌软膏治疗过敏性皮炎均有不错的临床疗效,但复方炉甘石洗剂的疗效在一定程度上优于氧化锌软膏。     

压力蒸汽对软膏缸内物品灭菌效果的试验观察

为观察压力蒸汽对１３５６ｍｌ软膏缸内物品的灭菌效果,在缸内物品中部与底部放置化学指示卡检测。结果,在１２４～１２８℃压力蒸汽作用３０ｍｉｎ后,加盖的空软膏缸内化学指示卡不变标准黑色。为此,对装有纱布块、棉球或棉签（占缸内容积３／４）的软膏缸不加盖,外包以双层布;但经上述灭菌处理后,合格率仍均为０．０％（０／１４）。纱布块、棉球、棉签不宜装在软膏缸内进行压力蒸汽灭菌。     

MULTIDISCIPLINARY PAIN ABSTRACTS: 34

Because recent studies emphasized the role of peripherally distributed N-methyl-D-aspartate (NMDA) receptors in processing the nociceptive information, the authors investigated whether peripheral application of the ointment containing ketoconazole (KET) is able to attenuate the symptoms of local neuropathic pain. They applied ointment containing KET (0.25%–1.5%) to the affected area on limbs in five patients with complex regional pain syndrome type I (CRPS I) and in two patients with type II (CRPS II). One to 2 weeks later, they observed improvement of the report of pain intensity, measured by the visual analog scale, in four patients with acute early dystrophic stage of CRPS I. Swelling of the affected limbs subsided as well. No apparent changes were noticed in one patient with chronic atrophic stage of CRPS I and in both patients with CRPS II. The authors concluded that topical application of KET appears to be beneficial for the patients with acute early dystrophic stage of CRPS I because of either its local anesthetic effect or NMDA receptor antagonist action. Patients with chronic atrophic stage of CRPS I and CRPS II patients do not appear to respond to this treatment.     

Intralesional and topical glucocorticoids for pretibial myxedema: A case report and review of literature

Pretibial myxedema (PTM), an uncommon manifestation of Graves’ disease (GD), is a local autoimmune reaction in the cutaneous tissue. The treatment of PTM is a clinical challenge. We herein report on a patient with PTM who achieved complete remission by multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application for a self-controlled study. A 53-year-old male presented with a history of GD for 3.5 years and a history of PTM for 1.5 years. Physical examination revealed slight exophthalmos, a diffusely enlarged thyroid gland, and PTM of both lower extremities. One milliliter of triamcinolone acetonide (40 mg) was mixed well with 9 mL of 2% lidocaine in a 10 mL syringe. Multipoint intralesional injections into the skin lesions of the right lower extremity were conducted with 0.5 mL of the premixed solution. A halometasone ointment was used once daily for PTM of the left lower extremity until the PTM had remitted completely. The patient’s PTM achieved complete remission in both legs after an approximately 5-mo period of therpy that included triamcinolone injections once a week for 8 wk and then once a month for 2 mo for the right lower extremity and halometasone ointment application once daily for 8 wk and then once 3-5 d for 2 mo for the left lower extremity. The total dosage of triamcinolone acetonide for the right leg was 200 mg. Our experience with this patient suggests that multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application are safe, effective, and convenient treatments. However, the topical application of a glucocorticoid ointment is a more convenient treatment for patients with PTM.     

Clomiphene citrate ointment in the local treatment of condylomata acuminata

The hypothesis underlying local treatment of Condylomata acuminata with clomiphene citrate is based on the assumption that susceptibility to this disease in women depends on the relative amount of oestrogen receptors in the affected, as opposed to the unaffected areas. We postulate blockade of these skin receptors after local application of clomiphene citrate ointment. A pilot study was conducted in 15 patients aged 20-33 with Condylomata acuminata. After only 2 months a complete remission was recorded in 12 patients (= 80%).     

新氢松与丹皮酚软膏序贯使用联合荆肤止痒颗粒治疗婴儿湿疹61例疗效观察

目的观察新氢松与丹皮酚软膏序贯使用联合荆肤止瘁颗粒治疗婴儿湿疹的疗效及安全性。方法治疗组61例全程口服荆肤止痒颗粒1．5g，2次／d。第1周每天早、晚外涂新氢松软膏，中午外涂丹皮酚软膏；第2周早、晚外涂丹皮酚软膏，中午外涂新氢松软膏；第3周，早、晚外涂丹皮酚软膏。对照组59例连续外用新氢松软膏，前两周2次／d，第3周改为1次／d。两组均治疗3周判定疗效，治疗过程中观察不良反应。随访4周。结果治疗组痊愈率72．1％，对照组痊愈率54.2％（χ^2=4．14，P〈0.05）。治疗组复发率45．5％，对照组复发率71.9％（χ^2=5.26，P〈0．01）。两组均未见明显不良反应。结论新氢松与丹皮酚软膏序贯使用联合荆肤止痒颗粒治疗婴儿湿疹近、远期疗效均优于单用新氢松软膏，且安全可靠。     

苍耳子软膏治疗单纯疱疹的临床观察

目的：观察苍耳子软膏治疗单纯疱疹的临床疗效。方法I夕h用苍耳子软膏治疗由单纯疱疹病毒所致单纯疱疹60例,并与阿昔洛韦软膏治疗62例进行疗效比较。结果：苍耳子软膏组总有效率91．67％,阿昔洛韦软膏组总有效率91．94％,两组疗效比较差异无显著性（P〉0．05）。结论：苍耳子软膏可用于治疗单纯疱疹,其疗效与阿昔洛韦软膏相当。     

中药膏方应用概述

膏方记载历史悠久,具有因人、因时、因地疗病补虚、养生扶正的作用特点,充分体现了中医整体观念与辨证论治治疗理念。本文通过综述膏方的历史沿革、临床应用,归纳总结膏方的调治特点,并提出观点及展望,以期为膏方的临床推广应用提供参考。     

卤米松乳膏包敷治疗寻常型银屑病包敷频率的效果观察及护理

目的观察评价卤米松乳膏包敷治疗寻常型银屑病每日包敷与隔日包敷的疗效。方法随机选取临床诊断为寻常型银屑病的患者88例,并随机分为治疗组47例和对照组41例,两组年龄、性别、病情严重程度差异无统计学意义。治疗组给予卤米松乳膏四肢皮损包敷,1次／d;对照组给予卤米松乳膏四肢皮损包敷,隔日1次。两组均同时配合中药淀粉浴及紫外线光疗。两组于治疗前及治疗2周后分别进行银屑病面积和严重指数（PASI）评分,对比观察两组疗效。结果2周后两组患者皮损均有明显好转,其中治疗组有效率为72．34％,对照组为51．22％,两组间差异有统计学意义（P〈0．05）,治疗组疗效优于对照组。结论卤米松乳膏包敷1次／d较隔日1次治疗寻常型银屑病疗效好。     

Single-dose tioconazole compared with 3-day clotrimazole treatment in vulvovaginal candidiasis.

A total of 80 patients were equally randomized to receive a single dose of 6.5% tioconazole ointment or a 3-day course of 100-mg clotrimazole vaginal tablets for the treatment of vulvovaginal candidiasis. Of the 32 evaluable patients treated with tioconazole, 27 (84%) remained asymptomatic 4 weeks posttreatment, compared with 28 of 33 patients (85%) treated with clotrimazole. A total of 34 patients in each group could be evaluated for mycological response based on culture results 1 and 4 weeks after treatment. Twenty patients (59%) who received tioconazole and twenty-one patients (62%) who received clotrimazole remained culture negative 4 weeks after therapy. Of 40 patients who received tioconazole, 12 (30%) experienced local irritation or itching, compared with 2 of 40 patients (5%) treated with clotrimazole (P less than 0.01). Single-dose tioconazole ointment was as effective as a 3-day course of clotrimazole tablets, but significantly more patients in the tioconazole-treated group experienced local side effects.     

复方多黏菌素B软膏在老年非手术糖尿病足溃疡创面修复中的应用

目的探讨复方多黏菌素B软膏在老年糖尿病足溃疡创面非手术修复中的应用。方法 128例老年糖尿病足患者根据创面使用药物不同随机分为试验组(复方多黏菌素B组)及对照组(磺胺嘧啶银组),每组64例。分别在开始治疗后1、2、3、4周观察比较两组患者创面组织细菌定量、创面愈合率及表皮生长因子的表达。结果 (1)在开始治疗后3周时试验组患者创面组织细菌定量均值小于对照组(P<0.05),第4周后明显小于对照组(P<0.01);(2)两组患者创面愈合率在治疗1、2、3周后无统计学差异,4周后试验组创面愈合率明显高于对照组(P<0.01);(3)治疗3周后两组患者创面的表皮生长因子比较有统计学差异(P<0.05),第4周差异更明显(P<0.01)。结论复方多黏菌素B软膏适用于全身感染已被控制但局部感染较重、高龄、基础病变多、难以承受多次麻醉手术清创后植皮封闭创面的老年患者,对治疗修复糖尿病足溃疡创面是一种安全、有效、简易的外用药物。     

Phosphonoacetic Acid in the Treatment of Experimental Herpes Simplex Keratitis

In a rabbit model of herpes simplex corneal ulceration, 5% phosphonoacetic acid solution or ophthalmic ointment suppressed clinical disease and virus replication. The effect of 5% phosphonoacetic acid ointment was equivalent to that of 0.5% idoxuridine ointment in the treatment of this established herpetic eye infection.