ObjectiveTo explore the effects of Fuzheng Jianpi decoction on adverse reactions to chemotherapy in children with solid tumor. Methods The children with solid tumor who were in/out-patients in oncological surgery of Beijing Children’s Hospital during the period from January 2005 to January 2008 were enrolled in the study. The children were divided into the chemotherapy drug group (the control group) and the chemotherapy drug plus Fuzheng Jianpi decoction group (the treatment group) by randomized digital table. The decoction contained 17 Chinese herbs. The time of taking the decoction was from the day before beginning of each chemotherapy cycle to one week after the end of chemotherapy. The peripheral blood cell count, scores for adverse reactions, compliance and the situation of chemotherapy completion in the two groups during the sixth and twelfth month of chemotherapy were observed and compared. ResultsA total of 167 patients were enrolled in the study. The control group (84 cases) comprised 48 boys and 36 girls with average age of (3.8±2.6) years. The treatment group (83 cases) comprised 45 boys and 38 girls with average age of (3.7±2.7) years. The differences in tumor types, tumor stages, white blood cell count, platelet count, and hemoglobin concentration before chemotherapy between the two groups were not statistically significant (P>0.05 for all comparison). The white blood cell count and hemoglobin concentration in the treatment group were higher than those in the control group [(4.2±2.0)×109/L vs (3.1±1.9)×109/L, P<0.01;(95±20) g/L vs (87±15) g/L,P<0.05)], the difference in platelet count between the two groups was not statistically significant (P>0.05) during the sixth month of chemotherapy. Three indexes of children in the treatment group were higher than those in the control group [white blood cell count:(3.8±1.8)×109/L vs (3.0±1.6)×109/L,P<0.01;hemoglobin concentration:(87±23) g/L vs (80±18) g/L, P<0.05;platelet count:(170±65)×109/L vs (146±51)×109/L, P<0.05] during the twelfth month of chemotherapy. Compared with the control group, the severity of vomiting was reduced markedly, activities of daily living, appetite and body weight were increased in the treatment group during the sixth month and the twelfth month of chemotherapy, respectively. The differences were statistically significant (P<0.01 for all comparison). The severity of constipation in the treatment group was lighter than that in the control group during the sixth month of chemotherapy (P<0.01). The severity of pain in the treatment group was lighter than that in the control group during the twelfth month of chemotherapy (P<0.05). The chemotherapy compliance in the treatment group was better than that in the control group [86.7%(72/83) vs 69.0% (58/84), P<0.01)]. The rates of chemotherapy completion in the treatment group was higher than that in the control group [81.9%(68/83) vs 667% (56/84), P<0.05]. ConclusionFuzheng Jianpi decoction can reduce the severity of adverse reactions to chemotherapy and might be used as an adjuvant treatment in children receiving chemotherapy for solid tumor.
An 81-year-old man with aggravated rheumatoid arthritis received subcutaneous injection of recombinant human tumor necrosis factor-α receptorⅡ:IgG Fc fusion protein 25 mg twice weekly and oral methotrexate 10 mg once weekly. Thirteen months later, a painless mass was found in his left submandibular region. The man underwent surgical excision of his mass. Adenolymphoma was confirmed by pathological examination. The recombinant human tumor necrosis factor-α receptorⅡ:IgG Fc fusion protein and methotrexate were discontinued and he had no recurrence of lymphoma at an eight-month follow-up.
A 21-month-old boy with upper respiratory tract infection was given nimesulide granules 50 mg in 2 divided doses at 15-hour intervals. Three hours after taking the first dose, he developed convulsion, pallor and yellowish urine. Fifteen minutes after taking the second dose, he redeveloped convulsion, progressive worsening pallor, strong tea-colored urine. Laboratory tests showed the following levels and values: C-reactive protein 79.0 mg/L, white blood cell count 35.6×109/L, neutrophil count 27.1×109/L, hemoglobin 33.0g/L, platelet count 471×109/L, thrombin time 17.2 seconds,prothrombin time 20.4 seconds, international normalized ratio 1.63 and activated partial thromboplastin time 27.5 seconds, fibrinogen 2.95 g/L. He underwent electrocardiogram monitoring and received oxygen inhalation therapy, an IV infusion of dexamethasone, methylprednisolone and human immunoglobulin, an IV infusion of sodium bicarbonate, and a transfusion of washed red blood cells. The child worsened and presented with coma, twitching limbs, his blood pressure was 131/103 mm Hg and his heart rate was 153 beats/ min. He was treated with plasma exchange, anti-infective therapy, immunosuppressive drugs, hydration, and nutritional support, and then his condition improved. On hospital day 8, repeat routine blood tests showed a white blood cell count of 7.0×109/L, a neutrophil count of 5.3×109/L, a hemoglobin level of 117 g/L, a platelet count of 311×109/L, and a reticulocyte count of 0.02.
A 64-year-old male patient received thiamazole (10 mg two times every day orally ) and propranolol (10 mg three times every day orally ) for hyperthyroidism. Five days later, the patient developed skin rash with itching which improved after self-taking loratadine. On day 25, dosages of thiamazole and propranolol were adjusted to 10 mg three times daily and 20 mg three times daily, respectively, and he received hepatoprotective treatment as well. On day 9 after adjusting the dosages, the patient developed intermittent and migratory joint pain and limited joint mobility. On day 11, thiamazole was stopped and meloxicam was given. Two weeks after thiamazole discontinuation, his joint pain significantly improved without limited joint mobility.
A 55-year-old female received an IV infusion of matrine and glucose injection 250 ml once daily for liver cancer and cirrhosis. The next day, she developed watery diarrhea, and matrine and glucose injection was stopped immediately. On day 3, diarrhea disappeared. Two days later, the patient was readministered an IV infusion of matrine and glucose injection 250 ml once daily. On day 3, she presented with severe painless watery diarrhea. Despite receiving garlicin, norfloxacin, compound diphenoxylate, and cefoxitin, her diarrhea did not improve. On day 4, matrine and glucose injection was discontinued. The following day, the patient’s diarrhea resolved.
A 48-year-old male patient underwent resection of space-occupying lesion in his left tempus because of encephalopyosis with secondary epilepsy. The patient received an IV infusion of monosialotetrahexosylganglioside 40 mg and then an Ⅳ infusion of benzylpenicillin sodium 32 million U (negative skin test) on the first day after operation. About 5 minutes after infusion completion, the patient developed agitation, lip cyanosis, coarse breath sound with audible wheezes in the lungs. His respiratory rate (RR) increased to 30-40 breathes/min, his heart rate (HR) increased to 178 beats/min, his blood pressure decreased to 80-88/48-60 mm Hg, and his blood oxygen saturation was 0.60. The patient immediately received oropharyngeal ventilation tube, sputum aspiration, mask oxygen, tracheal intubation, and assisted breathing by a ventilator, followed by an IV infusion of dopamine 100 mg, metaraminol 40 mg, methylprednisolone 0.5 g, an IV bolus of deslanoside 0.2 mg and dexamethasone 4 mg. Two hours later, his HR and RR decreased to 110 beats/min and 19 breathes/min, respectively, and his blood pressure and blood oxygen saturation increased to 125-135/70-90 mm Hg and 1.00, respectively. His vital signs were stable. The anaphylactic shock was suspected to be associated with benzylpenicillin sodium. On the second day after operation, benzylpenicillin sodium was withdraw and an IV infusion of monosialotetrahexosylganglioside 40 mg in 0.9% sodium chloride solution 100 ml was continued. About 10 minutes later, the patient developed agitation and tachypnea again, his HR increased to 160 beats/min, his blood oxygen saturation decreased to 0.85, and his blood pressure decreased to 77/45 mm Hg. The IV infusion was stopped immediately. Symptomatic treatment such as mechanical ventilation, increasing blood pressure, decreasing HR, anti-anaphylaxis, and anti-inflammatory agents was given. Forty minutes later, his HR and RR decreased to 110 beats/min and 18 breathes/min, respectively, and his blood pressure and blood oxygen saturation increased to 110-145/60-90 mmHg and 0.98, respectively. The patient ’s vital signs were stable.
A 50-year-old man received an intravenous infusion of amiodarone 150 mg via a pump for arrhythmia. About 5 minutes after infusion initiation, the patient developed an electric shock-like lower back pain and pallor. The infusion was stopped immediately and, about 15 minutes after drug discontinuation, his symptoms completely relieved. Ten minutes after remission, an IV infusion of amiodarone via a pump was readministered and, about 3 minutes later, an electric shock-like lower back pain recurred. The infusion was stopped immediately. About 5 minutes later, his back pain vanished entirely.
A 60-year-old male with fracture received an IV infusion of propylgallate 180 mg in 0.9% sodium chloride 250 ml for prevention of deep vein thrombosis after undergoing surgery. About ten minutes later,the patient abruptly developed chest tightness, dyspnea, pallor, lip cyanosis, and cold peripheral extremities. ECG monitoring revealed a heart rate of 104 beats/min, his blood oxygen saturation was 0.85, and his blood pressure was 80/50 mm Hg. Propylgallate was discontinued immediately. Anti-allergic treatment, blood volume expansion, and mask oxygen were given. Twenty minutes later, his anaphylactic symptoms gradually improved, his blood oxygen saturation increased to 0.96, and his blood pressure increased to 100/58 mm Hg.
A 74-year-old female patient received a preventive use of SC nadroparin calcium 6150 U once a day after undergoing right knee joint replacement surgery. Three days after operation, ecchymoses occurred at the location on her right waist and hip joint. The routine blood test showed a platelet count of 49×109/L and a hemoglobin level of 81 g/L. He then received a transfusion of concentrated red blood cells 400 ml. However, the ecchymoses diffused to the opposite waist and back. On day 5 after operation, nadroparin calcium was considered to be related to thrombocytopenia. Subsequently, nadroparin calcium was discontinued. On day 8 after operation, the color of ecchymoses faded and the platelet count was 88×109/L. On day 10, the patient was discharged with a platelet count of 123×109/L.
A 39-year-old man with chronic active hepatitis B and type 2 diabetes mellitus received compound glycyrrhizin, glutathione, polyene phosphatidylcholine, coenzyme complex, alprostadil, thymopentin and diammonium glycyrrhizinate, followed by entecavir, acarbose, and bicyclol. He then developed scattered maculopapular involving his entire body, with partial confluence on his chest and abdomen. Drug-induced rash was considered. All drugs were discontinued except entecavir. He was treated with methylprednisolone, calcium gluconate, vitamin C and loratadine, but these were ineffective. He subsequently had a large area of skin rash and worsening edema with blister, erosion, and desquamation. He was diagnosed with toxic epidermal necrolysis associated with entecavir. Entecavir was discontinued immediately and anti-anaphylactic treatment was continued. Ten days after the withdrawal of the entecavir, his skin lesions improved and, twenty days later, his skin eruptions disappeared completely.
A 44-year-old male patient deliberately ingested about 50 tablets of reserpine, and he was brought to the hospital emergency department with vomiting, nausea, dizziness, and asthenia. The patient was treated with an IV infusion of 50 ml of Xuebijing injection in 0.9% sodium chloride 250 ml. About 5 minutes later, the patient suddenly presented with tachypnea, hidrosis, facial flushing, palpitation, chest tightness, and dyspnea. Moreover, his blood pressure was 73/50 mm Hg, his heart rate was 93 beats/min and, his respiratory rate was 22 breaths/min. The infusion was stopped immediately. Hydrocortisone, dexamethasone, and dopamine were given and, in the meantime, he underwent oxygen inhalation and electrocardiogram monitoring. Thirty minutes later, his conditions improved and blood pressure increased to 106/76 mm Hg.