Effect of surgery combined with aminolevulinic acid-based photodynamic therapy on the recurrence of extramammary Paget's disease / 中华皮肤科杂志

Objective To evaluate the effect of surgery combined with aminolevulinic acid (ALA)-based photodynamic therapy (PDT) on the prognosis of extramammary Paget's disease.Methods A prospective open-labelled controlled trial was conducted.A total of 38 patients with pathologically comfirmed extramammary Paget's disease were enrolled from Shanghai Dermatology Hospital,and divided into 2 groups to be treated with surgery alone (surgery alone group,n =21) or surgery combined with ALA-PDT (combination group,n =17).Patients in the combination group received ALA-PDT after the surgery once every two weeks for 3 sessions.All the patients were followed up once every three months for more than 12 months,and the incidence of relapse was evaluated and compared between the 2 groups after the treatment.Results During the follow-up of 12-58 months (mean,35.45 ± 16.98 months),7 patients in the surgery alone group experienced relapse,and the median time to relapse was 9 months,with an upper quartile of 18 months and a lower quartile of 6 months.However,relapse only occurred in 1 patient in the combination group,and the time to relapse was 18 months after the end of treatment.The recurrence rate was significantly lower in the combination group than in the surgery alone group (P ＜ 0.05),and the time to relapse was also longer in the combination group than in the surgery alone group.Furthermore,ALA-PDT after the surgery was well tolerated in all the patients.Conclusion Surgery combined with ALA-PDT can reduce the recurrence rate of extramammary Paget's disease,and improve its prognosis.

Cryptococcosis in China (1985-2010): review of cases from Chinese database.

BACKGROUND: Cryptococcosis is a potential fatal disease, especially in immunocompromised patients. In China, the profile of cryptococcosis is unclear. Therefore, we summarize the epidemiology and therapy of cryptococcosis in china. METHODS: All cases reports about cryptococcosis in China were collected from CBMdisk database (China Biology and Medicine data disc) with key words of cryptococcosis, or cryptococcal infection, or cryptococcus, and case. The features of the cryptococcosis were retrospectively analyzed. RESULTS: There were 1,032 reports about cryptococcosis, including 8,769 cases. Among them, there were 16% patient with AIDS/HIV, and 17% ones without underlying diseases. There were 2,371 cases of CNS infection. Among them of 2,068 cases, the treatment protocols and outcome were clearly described. The percentages of patients who received intrathecal treatment of amphotericin B(AmB), AmB + 5-FC(5-fluorocytosine), AmB + FCZ(fluconazole), and AmB + 5-FU + FCZ in each medication group were 10, 43, 53, and 33%, respectively. The mortalities were significantly lower in the AmB, Amb + 5-FC, AmB + FCZ intrathecal treatment groups compared with their non-intrathecal treatment controls (6% vs. 23%, 25% vs. 35%, 20% vs. 30%, respectively, P < 0.05), but not in the intrathecal AmB + 5-FU + FCZ group (35% vs. 26%, P > 0.05). CONCLUSION: The Chinese cryptococcosis had its own special clinical features, such as more patients without identifiable underlying diseases. Intrathecal injection of amphotericin B was effective treatment method for cryptococcal CNS infection in China.

Lumbar puncture drainage with intrathecal injection of amphotericin B for control of cryptococcal meningitis.

Cryptococcal meningitis is a disease with high mortality and refractory to intravenous antifungal treatments with agents such as amphotericin B and fluconazole. We investigated lumbar puncture catheter drainage with an intrathecal injection of amphotericin B as a treatment for cryptococcal meningitis. All of the 14 patients enrolled in the treatment group survived with no evidence of relapse during 1-year follow-up. Complications included lumbosacral nerve root irritation in seven patients and urinary retention in seven patients. This study demonstrated that the technique used was effective in controlling the symptoms. The major complications disappeared after discontinuation of intrathecal injection of amphotericin B or with low-dose therapy. Therefore, this technique could be an effective and safe method for the treatment of cryptococcal meningitis.

Effect of continous renal replacement treatment in severe burn patients with acute renal failure / 中国基层医药

Objective To investigate the changes in severe burn patients with acute renal failure by using continuous blood purification(CBP). Methods Twelve severe bum patients underwent early CBP were included in this study. The levels of creatinine、blood urea nitrogen and interleukin-6(IL-6) in plasma were determined. The termperature and heart were also observed. Results After the treatment of CBP,the clinical symptoms were improved obviously ( P ＜ 0. 05 ). The levels of creatinine[( 376. 2 ± 24. 5 ) μ mol/L vs ( 145.2 ± 57. 1 ) μmol/L] 、sodium concentration [( 5.3 ± 1.6 ) mmol/L vs ( 4. 0 ± 0. 7 ) mmol/L] and potassium concentration [( 153. 4 ± 13.0 ) mmol/L vs( 140. 1 ±8.6)mmol/L]in plasma were all decreased evidently after the treatment of CBP. There were significant differences ( t = 2. 79,3.06,3. 01, P ＜ 0. 05 ). The levels of IL-6 and APACHE Ⅱ score were ( 264. 31 ± 122.42 ) ng/Land( 15.2 ±5.8) scores before treatment. While after treatment,their levels were(94. 18 ±63. 82) ng/L and(5.4 ±3. 6) scores. The difference was also significant ( t = 4. 17,3. 67, P ＜ 0. 05 ). In this study, 8 patients cured and 4 patients died. Conclusion CBP could eliminate inflammation factors effectively in severe burn patients with acute renal failure. It could afford a useful assist treatment to these patients.

Aspergillosis of biliary tract after liver transplantation: a case report.

We reported a case of aspergillosis presented as cholangitis in a patient after liver transplantation, even with prophylactic use of fluconazole. The patient had multiple predisposing factors, such as leukocytopenia, immunosuppressive drug therapy. He died 2 days after an exploratory laparotomy was carried out. The histopathologic finding of biopsy specimen from biliary tract was positive for Aspergillus. And the pathogen was identified as Aspergillus flavus by mycological culture and PCR. The patient was confirmed as a case of Aspergillosis of biliary tract that was responded poorly to fluconazole. This indicated that azole should have been switched to more effective antifungal agents at earlier stage when the patients responded poorly to the original treatment.

Primary Cutaneous Nocardiosis Associated with Intramuscular Injection / 中华皮肤科杂志

Objective To investigate and report a group of patients with cutaneous nocardiosis occurring in China.Methods The skin lesion of twenty-three patients were examined and the pathogen was identified.The possible cause of this disease was also investigated.Results All the twenty-three patients belon g to a same village in a province.Skin lesions on buttoc ks manifested as nodules and abscesses whereas some other lesions as ulcers and draining sinuses,occurring 2-10mo nths after intramuscular injection.The pathogens were identified as Nocardia asteroides.Conclusion Twenty-three patients of cutaneous nocardiosis were related to intramu scular injection.