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Pruritus různé intenzity byl zjištěn u 58 % pacientů. Z toho ve 27 % byl přítomen již před zahájením dialýzy. U 15 % nemocných se jednalo o generalizovaný pruritus, stejné procento pacientů uvedlo, že trpí vlivem svědění poruchami spánku. Analýza pruritu podle metody dialýzy a přítomnosti diabetes mellitus neodhalila významné rozdíly. Intenzita pruritu nezávisela na délce dialýzy. U pacientů se zavedenou terapií pruritu antihistaminiky a emoliencii byla léčba úspěšná v 70 % u diabetiků a v 74 % u nediabetiků. Další kožní změny zahrnovaly suchost kůže (87 %), elastosis cutis (67 %), mykotické, bakteriální či virové kožní infekce (58 %), bledost (51 %), kožní hematomy a ekchymózy (41 %), pigmentace (28 %), zhoršené hojení ran (28 %), lamelární deskvamaci (26 %), makroglosii (22 %), kožní léze klinicky suspektní z malignity (8 %), half-and-half nails (5 %), bulózní dermatózy (5 %), prurigo nodularis (2 %), kalcifikace (1 %), gynekomastii (1 %) a perforující dermatózy (1 %). Závěr: Chronické selhání ledvin je spojeno s četnými kožními změnami s významným dopadem na kvalitu života pacientů, proto je žádoucí pravidelné sledování dermatologem.

Objective: Assessment of skin changes and characteristics of pruritus in patients with chronic renal failure. Methods: The project consisted of clinical check-up and questionnaire focused on pruritus and skin changes. Results: In total, 58% of patients experienced pruritus that appeared prior to initiation of dialysis in 27% of them. In 15 % of patients the pruritus was generalized. The same percent reported on pruritus-associated sleep disorders. Analysis of pruritus according to method of dialysis and presence of diabetes mellitus did not reveal significant differences. Pruritus intensity was not dependent on the length of dialysis. In patients with antipruriginous therapy with antihistamines and emollients the treatment was successful in 70% of diabetic patients and in 74% of non-diabetics. Other cutaneous manifestations included skin dryness (87%), elastosis (67%), fungal, bacterial or viral infections (58%), pallor (51%), bruising/ecchymoses (41%), pigmentation (28%), worsened wound healing (28%), ichtyosiform scaling (26%), macroglossia (22%), skin lesions clinically suspicious of malignancy (8%), half-and-half nails (5%), bullous dermatoses (5%), prurigo nodularis (2%), calcifications (1%), gynecomastia (1%), and perforating disorders (1%). Conclusion: Chronic renal failure is associated with numerous skin changes with great impact on patient quality of life. Regular dermatological examination to reveal present skin abnormalities and following medical intervention are therefore desirable.

MeSH
antihistaminika terapeutické užití MeSH
chronické selhání ledvin komplikace MeSH
dialýza škodlivé účinky MeSH
ekchymóza etiologie MeSH
gynekomastie etiologie MeSH
infekční nemoci kůže etiologie MeSH
lidé MeSH
makroglosie etiologie MeSH
melanom etiologie MeSH
metabolické nemoci kůže etiologie MeSH
náhrada funkce ledvin metody škodlivé účinky MeSH
prurigo etiologie klasifikace MeSH
pruritus etiologie klasifikace MeSH
průzkumy a dotazníky využití MeSH
vezikulobulózní nemoci kůže etiologie MeSH
Check Tag
lidé MeSH
Publikační typ
hodnotící studie MeSH

Abstrakt

Chlamydiové infekce genitálu : III. kongres českých a slovenských dermatovenerologů, Praha, 14.-16.6.2007. Abstrakt

Lékařské listy. 2007 ; 56 (11) : 19.

Medvik
Zdroj

MeSH
chlamydiové infekce diagnóza epidemiologie etiologie MeSH
lidé MeSH
plošný screening metody MeSH
prostituce MeSH
urogenitální systém patologie MeSH
Check Tag
lidé MeSH
Geografické názvy
Česká republika MeSH

Článek

Genital warts treated by photodynamic therapy

SKINmed. 2007 ; 6 (6) : 295-297.

Skinmed
ISSN 1540-9740
Medvik
Zdroj

The patient, a 30-year-old man with numerous genital condylomata acuminata (CA), has had unsuccessful treatment with liquid nitrogen, 20% podophyllin, and repeated 0.5% podophyllotoxin solution with 5% imiquimod (Figure 1). Before the appearance of CA, he experienced acute orchiepididimitis and a Candida infection. The patient was immunologically examined, and the lower level of lymphocytes, slightly reduced level of IgM, and C4 complement were revealed. Results from a human immunodeficiency virus examination were negative. After the therapeutic failure mentioned above, photodynamic therapy (PDT) was initiated using 20% aminolevulinic acid (5-ALA) in a gel. The photosensitizer was applied to lesions and 10 mm of surrounding skin in a 1-mm-thick layer under occlusive dressing for 3 hours and then removed with saline and nonwoven gauze. The site was immediately irradiated with noncoherent red light with an emission spectrum of 580 to 680 nm wavelength (Medeikonos PDT-Model 200, Medeikonos AB, Sweden). The total light dose was 50 J/cm(2); light intensity ranged from 70 to 90 mW/cm(2). Because of persistent fluorescence during photodynamic therapy, the treatment was repeated 10 times in 2-week intervals with a follow-up of 1, 3, and 6 months after its completion. After the last PDT treatment, the persistent fluorescence disappeared completely. The absence of fluorescence corresponded with a healed clinical finding without scarring and pigmentation (Figure 2). The period from the initiation of PDT to the consolidation of CA was 22 weeks. During PDT treatment, the patient felt only mild burning, which disappeared after the illumination stopped. Six months after the therapy, there were no signs of recurrent disease.