2010 Volume 12 Issue 6 Published: 28 December 2010
  

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    实验论著

  • 实验论著
    Experiment study on hepatotoxicity induced by the water extract of cocklebur fruit in rats
    Wu Bin;Cao Min;Liu Shumin;Jin Yong;Wang Yu
    2010, 12(6): 381-6.
    Abstract ( ) PDF ( )

    Objective: To observe the effects of different concentrations of water extracts of cocklebur fruit on liver function and morphology in rats, in order to provide experimental evidence for safe use of cocklebur fruit in clinical practice. Methods: Twentytwo kilogram of ground cocklebur fruit was extracted with 65% alcohol. The alcohol extractions was extracted with petroleum ether, ethyl acetate and nbutanol in turn. The organic solvents were retrieved. Seven hundred and fortythree point six gram of water extracts of cocklebur fruit was obtained. The water extracts was mixed with normal saline solution containing 3% Tween80, and two different concentrations of suspensions (28.00 mg/mL and 1.12 mg/mL) was prepared. One hundred and fortyfour SPF SD male rats, weighing (200±10)g, were divided into the highdose group, the lowdose group and the control group by randomdigit table method, each group comprised 48 rats. The 2.5mL of 28.00 g/mL suspension and 2.5mL of 1.12 g/mL suspension were perfused into the rats’stomach in the high-dose and the low-dose groups twice daily, respectively. The rats in the control group was perfused with same volume of normal saline solution containing 3% Tween80 twice daily. The duration of gavage feeding was 28 days. The appearance, intake of food, and activities of rats were observed. The body weight of the rats were weighed, the serum levels of ALT, AST and AKP were measured 7, 14, 21, and 28 days after drug initiation and 7, 14 days after drug withdrawal, respectively. Subsequently, the rats were sacrificed, the liver index was calculated(liver weight/body weight×100%) and the liver histopathology was scored and graded. Results: During a 28day period of medication, the rats in the highdose group developed erect hair, epilation, lassitude, anorexia, and were unresponsive to stimuli. Only a few rats in the lowdose group developed lassitude and listlessness. Fourteen days after drug withdrawal, the rats’activities and intake of food were increased, degree of lassitude improved and the gloss of coat normalized in the highdose group. Twentyone and 28 days after drug initiation and 7 days after drug withdrawal, the body weight of rats in the highdose group[(10.5±4.2),(10.2±3.1),(12.1±4.5) g] were markedly lower than those in the lowdose group[(15.3±2.10), (16.7±4.2), (17.6±3.2) g\] and the control group[(18.6±3.4), (20.5±5.2), (19.6±2.5)g]，the serum levels of ALT[(42.8±3.2), (49.3±5.9), (43.2±3.2)U/L], AST[(108.8±11.7), (119.8±16.3), 110.5±17.6)U/L] were markedly higher than those in the lowdose group [(33.7±4.6), (34.8±5.4), ( 33.5±4.9)U/L，(94.7±12.6), (95.4±10.7), (96.8±12.8)U/L]and the control group[(31.2±4.3), (32.5±6.3), (31.7±5.7)U/L, (92.3±16.2), (92.9±20.3), (93.7±16.3)U/L], the serum levels of AKP [(197.2±25.7), (210.4±41.8), (189.3+17.6)U/L] were markedly higher than those in the lowdose group [(174.3±22.6), (175.3±27.4), (176.3±22.8)U/L]and the control group [(171.3±25.6), (172.5±28.7), (172.8±26.3)U/L].Twentyone and 28 days after drug initiation and 7 days after withdrawal, the liver indexes in the highdose group（4.2±0.4, 5.0±0.7, 4.9±0.3）were markedly higher than those in the lowdose group and the control group[(3.4±0.6, 3.6±0.6, 3.9±0.6), (3.0±0.4, 3.2±0.3, 3.4±0.5)]. Fourteen, 21 and 28 days after drug initiation and 7 days after drug withdrawal, the median score of liver pathology in the highdose group (1.0, 1.5, 3.0, 1.5) were markedly higher than those in the lowdose group (0.2, 0.5, 0.8, 0.5) and the control group(0.1, 0.1, 0.2, 0.1). The differences of each index mentioned above between the highdose group and the lowdose group as well as the control group were statistically significant(P＜0.05, P＜0.01) , but the differences between the lowdose group and the control group were no statistically significant(P＞0.05). Conclusion: The rat’s liver damage due to the water extract of cocklebur fruit is related to its dosage and duration of drug use; highdose and prolonged use may increase liver damage.

  • 实验论著
    Study on screening the carboplatinresistant human ovarian cancerrelated protein
    Feng Tongfu;Wang Qi;Zhang Wei;Li Danrong;Li Li
    2010, 12(6): 387-6.
    Abstract ( ) PDF ( )

    Objective: To screen carboplatinresistant human ovarian cancerrelated protein in order to explore the molecular mechanism of resistance at the protein level. Methods: The total proteins of parental (SKOV3) and carboplatinresistant (SKOV3/CB) cell lines derived from human ovarian cancer were extracted, the differentially expressed proteins were separated and screened by twodimensional liquid chromatography. The proteins were identified by electrospray ionizationtandem mass spectrometry (ESIMS/MS). Results: A total of 54 differentially expressed proteins were isolated and screened. Of these proteins, the expression of 20 proteins were upregulated in SKOV3 cell line and the expression of 34 proteins were upregulated in SKOV3/CB cell line. Four proteins whose expression were upregulated in SKOV3/CB cell line associated with carboplatin resistance were identified, including superoxide dismutase, cyclindependent kinase 6 inhibitor, transcriptional adapter 1 protein，and proapoptotic caspase adapter protein. These proteins were associated with oxidation and reduction，cell cycle control，apoptosis and others. Conclusion: The mechanism of carboplatin resistance in the human ovarian cancer may be related to different kinds of proteins; and these experimental data will be valuable for further study of platinum resistance in the human ovarian cancer.

    • 临床论著

  • 临床论著
    Clinical analysis of effects of pituitrin on serum sodium levels in patients with hemoptysis
    Liang Ying;Mi Yuhong;Liu Shuang
    2010, 12(6): 393-4.
    Abstract ( ) PDF ( )
    Objective: To analyze the clinical characteristics of effects of pituitrin on serum sodium levels in the patients with hemoptysis. Methods: Between October 2006 and October 2009, the clinical data from the patients with hemoptysis receiving pituitrin in emergency intensive care unit(EICU) of Beijing Anzhen Hospital Affiliated to Capital Medical University were collected and retrospectively analyzed. Results: A total of 14 patients with hemoptysis received pituitrin. The initial dose of pituitrin 3-5 U in 20 mL of 0.9% sodium chloride was given by slowly intravenous push, and then pituitrin 6-12 U in 250 mL of 0.9% sodium chloride was given by intravenous infusion. After bleeding cessation, pituitrin was given in a dose of 6-12 U in 250 mL 0.9% sodium chloride by intravenous infusion, lasting 24-48 hours, and then the drug was discontinued. Four patients’bleeding ceassed after one day of pituitrin therapy, and then the drug was stopped, their serum sodium levels showed no change. Ten patients’bleeding ceased after 2-12 days of pituitrin therapy, and then the drug was withdrawal, their serum sodium levels decreased from (137.4±1.3)mmol/L(on admission) to (124.9±5.6) mmol/L (P＜0.05). The ten patients comprised 4 male and 6 female with age of 47-79 years (mean age 62 years). Of them, 9 patients received pituitrin for 2-9 days(mean duration 4 days), and their mean cumulative dosage of pituitrin was 57 U(24-108 U). They presented with nausea, vomiting, dizziness and fatigue and were diagnosed with mild hyponatremia. Another patient received pituitrin for 12 days, and the cumulative dosage of pituitrin was 124 U. The patient developed torpor and lethargy, followed by transient polyuria after drug withdrawal and was diagnosed with severe hyponatremia. All patients with hyponatremia were treated with 3%- 4% sodium chloride by intravenous infusion for sodium supplement.Their serum sodium levels increased from (124.9±5.6) mmol/L to (138.1±1.2) mmol/L (P＜0.05). After symptomatic treatment, all patients recovered and were discharged. Conclusion: The patients’clinical presentations and serum sodium levels should be closely monitored during treatment of hemoptysis with pituitrin. Once hyponatremia occur, pituitrin should be discontinued and the symptomatic treatment should be given.

  • Acute urinary retention due to propantheline
    Zou Gongmina;Zhang Xuefenga;Zhang Shilinb
    2010, 12(6): 396-1.
    Abstract ( ) PDF ( )
    A 45yearold male patient with nephrolithiasis selfmedicated with oral propantheline 30 mg for loin and abdomen pain. One hour later, his abdominal pain relieved, but he presented with dry mouth, palpitations, and facial flushing followed by lower abdominal pain and distension, dysuria, and bladder filling. Acute urinary retention was considered. He was placed with a urinary catheter and then he urinated about 2 000 mL in 4 hours. His abdominal distention disappeared and his urinary function gradually normalized. The second day, he urinated by himself.

    • 调查研究

  • 调查研究
    Comparative study on adverse reactions of amoxicillin versus amoxicillin/clavulanate potassium
    Liu Guiyang;Yu Fengying;Chen Chao;Ma Liang;Wang Yuyu
    2010, 12(6): 397-4.
    Abstract ( )
    Objective: To compare the adverse reactions of amoxicillin and amoxicillin/clavulanate potassium in order to provide a reference for safe drug use in clinical practice. Methods: The adverse reaction reports associated with amoxicillin and amoxicillin/clavulanate potassium from database of PLA Adverse Drug Reaction Monitoring Center between march 2000 and march 2010 were collected and retrospectively analyzed. The reported cases were divided into two groups: the amoxicillin group and the amoxicillin/clavulanate potassium group. The clinical manifestations, outcomes, and severity of adverse reactions, the influences of adverse reactions on the primary diseases, and the time to adverse reaction onset were compared between the two groups. Results: A total of 576 adverse reaction reports associated with amoxicillin and amoxicillin/clavulanate potassium were collected. Of the reports, 438 adverse reaction reports associated with amoxicillin involved 814 adverse reactions, and 138 adverse reaction reports associated with amoxicillin/clavulanate potassium involved 233 adverse reactions. The amoxicillin group comprised 220 men and 218 women with a mean age of (36.4±19.0) years, and the amoxicillin/clavulanate potassium group comprised 62 men and 76 women with a mean age of (40.4±20.9) years. The percentages of skin and appendages disorders, gastrointestinal system disorders, circulatory system disorders, and central nervous system disorders occurring in patients in the amoxicillin and amoxicillin/clavulanate potassium groups were 77.4%(n=630) vs 55.8%(130) , 5.3%(43) vs 19.7%(46) , 1.3%(11) vs 4.3%(10), and 1.3%(11) vs 4.3%(10), respectively. The percentages of cases of nonserious and serious adverse reactions in the two groups were 92.5% (405 cases) vs 97.8% (135 cases) and 7.5% (33 cases) vs 2.2% (3 cases) , respectively. As to the influence of adverse reactions on primary diseases in the two groups, the percentages of marked and no marked influences were 9.1% (40 cases) vs 1.4% (2 cases), 90.9% (398 cases) vs 98.6% (136 cases), respectively. The differences between the 2 groups in all above indexes were statistically significant (All P<0.05). The median time to adverse reactions onset in the two groups were 3 days and 1 day, respectively. Conclusion: The clinical use of amoxicillin/clavulanate in treating infectious diseases appears to be relatively safe compared with amoxicillin.

    • 安全用药

  • 安全用药
    The safety of anti-hepatitis B virus nucleoside (nucleotide) analogues used in pregnant and breastfeeding women
    Cai Haodonga;Liu Minb
    2010, 12(6): 401-5.
    Abstract ( ) PDF ( )
    Antiviral therapy is generally accepted as an important therapeutic measure for hepatitis B. But there are much controversies over the safety of antihepatitis B virus (HBV) nucleoside (nucleotide) analogues used in pregnant and breastfeeding women. This article reviews the recent medical literatures regarding antiHBV nucleoside (nucleotide) analogues used in pregnant and breastfeeding women in order to provide evidences of antiviral therapy in treating HBVinfected pregnant and breastfeeding women and preventing mothertoinfant HBV vertical transmission.
  • 安全用药
    Quinolone-induced achilles tendon injury
    Liu Rong;Zhang Haiying
    2010, 12(6): 406-4.
    Abstract ( ) PDF ( )
    Quinolones are synthetic broadspectrum antibiotics. With the widespread use of quinolone, the case reports about achilles tendon injury are increasing. The common medicines causing achilles tendon injury include ciprofloxacin, norfloxacin, gatifloxacin, enoxacin, moxifloxacin, and levofloxacin. The mechanisms of quinoloneinduced achilles tendon injury may be related to cell damage, local magnesium deficiency and tissue necrosis. The major clinical manifestations of achilles tendon injury are unilateral or bilateral achilles tendon pain and inflammatory edema, and in severe cases achilles tendon rupture may occur. According to the report, the average time to achilles tendon injury onset is six days after drug start and the average time to recovery is fourteen days after drug discontinuation. The most common risk factors for achilles tendon injury are concomitant corticosteroid therapy, renal insufficiency, advanced age, hyperthroidism, diuretic use, peripheral vascular diseases, rheumatoid arthritis, diabetes mellitus, and strenous sports activity. Once symptoms associated with achilles tendon injury occur, the drug should be withdrawn immediately, activities should be stopped, and corticosteroids can be given for relieving swelling and pain. Quinolonesinduced achilles tendon injury can lead to serious consequences. Therefore, indiscriminate use of qinolones should be avoided and the drugs should be used with caution in patients with risk factors.

    • 病例报告

  • 病例报告
    Zolpidem-induced urinary incontinence
    Sun Xiangju;Wu Yubo;Jiang Aihua
    2010, 12(6): 409-2.
    Abstract ( ) PDF ( )
    A 57yearold male patient was hospitalized with cerebral infarction and received ozagrel, aspirin and fusudil. On day 7, he took zolpidem 10 mg due to insomnia and anxiety at bed time. The patient presented with urinary incontinence at night. The next day, he had no memory of the event. After a day’s interval, his zolpidem dose was decreased to 5 mg. The patient’s abovementioned symptoms recurred after repeated administration of zolpidem. A review of his history revealed that, a few months earlier, he had received zolpidem and had developed the same reaction.

    • 安全用药

  • 安全用药
    Adverse reactions of pharmaceutical excipients and their safety management
    Lü Qiujun;Cao Ping
    2010, 12(6): 410-5.
    Abstract ( ) PDF ( )
    Pharmaceutical excipients refer to any substances other than the active principal in the pharmaceutical preparation. Their functions are to protect, support or enhance the stability and bioavailability of the active ingredient besides formulating a dosage form. It is reckoned that 40 kinds and more of pharmaceutical excipients including over one thousand different materials are now used in the manufacturing of pharmaceutical products, such as solvents, absorbents, preservations,colouring agents, flavouring agents, thickening agents, antioxidants, and so on. In addition，new classes of excipients have been available in recent years. Pharmaceutical excipients are considered to be inert in contrast to active drug. However, adverse reactions to a wide range of excipients are now documented, such as hemolysis to propylene glycol, gasping syndrome to benzyl alcohol, etc. The safety of pharmaceutical excipients involves their toxicity, quality, and improper use. The clinicians should be aware of the adverse reactions associated with pharmaceutical excipients, and drug regulatory authority should strengthen the management of the safety of pharmaceutical excipients in order to safeguard the patient safety.
  • 安全用药
    Total parenteral nutrition induced intestinal complications and their prevention
    Li Yunjing;Li Xueqin
    2010, 12(6): 415-4.
    Abstract ( ) PDF ( )

    Prolonged use of total parenteral nutrition(TPN) may induce intestinal complications. The clinical presentations of intestinal complications are abdominal pain, diarrhea, nausea, vomiting, water and electrolyte disturbance, and even a shock. The mechanisms of TPNinduced intestinal complications might be associated with atrophy intestinal mucosa and intestinal barrier damage, leading to bacterial overgrowth and translocation. The preventive measures for TPNinduced intestinal complications are as follows: the duration of TPN use should be decreased if possible; TPN should be combined with enteral nutrition as early as possible. Alanylglutamine,growth hormone, and some other nutritional factors can be added to solutions for TPN in patients who were prolonged use of TPN.

    • 中毒救治

  • 中毒救治
    Successful management of acute thallium poisoning with combination of prussian blue and blood purification treatment in two patients
    Shen Wei;Qiu Zewu;Peng Xiaobo
    2010, 12(6): 419-2.
    Abstract ( ) PDF ( )
    Two patients，a 36yearold man and a 68yearold woman，were hospitalized with numbness and stabbing pain in their extremities. The blood thallium concentrations in the patients 1 and 2 were 1 642 and 158 μg/L, respectively. Thallium poisoning was diagnosed. The patients were treated with oral prussian blue 250 mg/(kg·d), blood purification, etc. Subsequently, the blood thallium concentrations in the patients 1 and 2 gradually decreased to 5 and 4 μg/L, respectively; their clinical symptoms were significantly relieved.
  • 中毒救治
    Clinical analysis of acute blasting fume poisoning in six patients
    Liu Jingkai;Xu Puqin
    2010, 12(6): 421-3.
    Abstract ( ) PDF ( )
    Objective: To summarize the treatment experience of acute blasting fume poisoning. Methods: The clinical data from patients with acute blasting fume poisoning in our hospital from October 2007 to November 2009 were collected and retrospectively analyzed. Results: A total of 6 patients were hospitalized. They were all male with mean age 38 years (range 3443 years). The time to disorder onset was 3120 min. All 6 patients developed dizziness, headache, nausea, vomiting, and asthenia. Some of them were accompanied by unconsciousness (4 cases), convulsion (1 case), urinary incontinence (2 cases), dyspnea (2 cases), and so on. Chestexaminations showed one case of peribronchitis and one case of interstitial inflammation in both lungs. Encephalogram examination revealed one case of lowamplituded slow waves. After hyperbaric oxygen, symptomatic and supportive treatments, the 6 patients all improved and were discharged; two of them still had mild dizziness and headache. Conclusion: Early diagnosis and timely treatment with hyperbaric oxygen as well as symptomatic and supportive therapy are effective measures for successful management of acute blasting fume poisoning.
  • 中毒救治
    Amlodipine overdoseinduced multiple organ dysfunction syndrome (MODS) as well as pleural and abdominal effusions
    Zheng Wenbo;Ding Zhirong;Li Huangen
    2010, 12(6): 424-2.
    Abstract ( ) PDF ( )
    A 27yearold woman selfmedicated with 42 tablets of amlodipine 5 mg and, 30 minutes later, developed repeated vomiting accompanied by a BP of 73/41 mm Hg. She was given IV fluid supplement and dopamine via IV pump for maintaining blood pressure. On day 2 of admission, her urine volume decreased to 200 mL within 15 hours, her BUN and SCr were 12.4 mmol/L and 158 μmol/L，respectively. The patient gradually developed chest tightness, short of breath, SpO2 of 92% and facial edema. Ultrasound examination showed massive pleural and abdominal effusions, and she underwent pleural drainage for aspirating effusions and relieving oppressive symptoms in the heart and lungs. On hospital day 3, her ALT and AST levels were 117 U/L and 89 U/L, respectively. On day 5, the patient developed polyuria with a urine volume up to, on average, 4 000 mL a day, and her serum potassium levels decreased from 34 mmol/L to 2.5 mmol/L. She was treated with a potassium supplement. On day 7, her urine volume was normal and her serum potassium level increased to 3.45 mmol/L. Eleven days after hospitalisation,the patient recovered and was discharged.

    • 病例报告

  • 病例报告
    Acute renal failure associated with methotrexate chemotherapy
    Yang Wei;Gu Jian
    2010, 12(6): 426-3.
    Abstract ( ) PDF ( )
    A 14yearold girl with lymphoma stage Ⅳ was hospitalized and received her sixteenth course of chemotherapy. On admission, laboratory testing revealed the following levels: WBC count 5.58×109/L, Hb 88 g/L, PLT count 143×109/L, SCr 42 μmol/L, ALT 38 U/L. Her heart, liver and renal functions were almost normal. Methotrexate was given intravenously according to the following protocol: a total methotrexate dose of 4 g, one third of the total dose within 0.5 hour, and then the remaining dose within 23.5 hours. Meanwhile, dexmethasone 5 mg, cytarabine 40 mg, and methotrexate 12.5 mg were administered intrathecally, and IV vincristine 1.8 mg was given. On day 2 of chemotherapy，the girl developed fever, vomiting, diarrhea and edema in her lower limbs. On day 3, laboratory investigations showed the following levels: WBC count 2.49×109/L，PLT count 24×109/L，Hb 58.0 g/L, potassium 2.74 mmol/L，SCr 179 μmol/l，CK 1 089 U/L. Her blood methotrexate concentrations 24 and 42 hours after chemotherapy completion were 168.0 and 65.0 μmol/L, respectively. During blood purification period, her blood methotrexate concentrations were 36.5 μmol/L (66 h), 29.4 μmol/L (73 h), 22.1 μmol/L (77 h) and 16.0 μmol/L (90 h). On day 5 of chemotherapy, her urine volume decreased to 460 mL, followed by anuria and convulsions. After receiving IV diazepam 5 mg, her convulsions was relieved, but she still had agitation.
  • 病例报告
    Dicycloplatin resulting in pancytopenia
    Li Hui;Wang Meikang;Wang Ying;Gao Wa
    2010, 12(6): 428-2.
    Abstract ( ) PDF ( )
    A 71yearold man received an IV infusion of dicycloplatin 650 mg in 5% glucose 1000 mL for chemotherapy after undergoing excision of right lung cancer. The infusion was completed within 4 hours. The next day, the patient developed weakness in lower limbs and nausea. Three weeks later, he received his second chemotherapy course and the regimen was the same as the first chemotherapy. The next day, he developed nausea and right nasal cavity bleeding. Laboratory tests revealed the following levels: WBC count 3.04×109/L, N 0.50, L 0.37, Hb 83 g/L, RBC count 2.76×1012/L, PLT count 35×109/L. Local nasal cavity hemostasis and other symptomatic treatments were given immediately. Three days later, nasal cavity bleeding ceased and his routine blood tests normalized. Laboratory tests showed the following levels: WBC count 4.04×109/L, N 0.53, L 0.35, Hb 86 g/L, RBC count 4.16×1012/L, PLT count 87×109/L.
  • 病例报告
    Exfoliative dermatitis following an intravenous infusion of clindamycin
    Cairang Dangzhou;Wu Hailing
    2010, 12(6): 429-3.
    Abstract ( ) PDF ( )
    A 69yearold man received an IV infusion of clindamycin 0.6 g dissolved in 0.9% sodium chloride 250 mL for prevention of infections following ocular surgery. Twenty minutes later, the patient developed itching and aches in his chest and abdomen, followed by red maculopapular eruption. Clindamycininduced exfoliative dermatitis was diagnosed and the drug was discontinued. The patient was given an IV infusion of 10% calcium gluconate 10 mL and vitamin C 3.0 g added to 5% glucose 250 mL; he was also receiving dexamethasone 10 mg once daily via a Murphy’s dropper and oral loratadine 10 mg once daily. On day 2, furfuraceous skin desquamation occurred on his chest, abdomen, and upper thigh and, on day 3, large areas of exfoliation appeared on his chest and abdomen. After 10 days of treatment, the patient’s skin lesion resolved and he was discharged.
  • 病例报告
    Toxic epidermal necrolysis associated with imipenem/cilastatin sodium
    Du Jubaoa;Chu Yanqib;Guo Shuang;Qi Xiaolianb;Zhao Chenc
    2010, 12(6): 431-3.
    Abstract ( ) PDF ( )
    A 45yearold man received cefminox, monosialoteterahexosylganglioside, edaravone and gingko biloba flavonal glycosides for spinal injury and pulmonary infections after operation of cervical disc prolapse. One day later, cefminox was stopped, and the patient was given an IV infusion of imipenem/cilastatin sodium 0.5 g every eight hours. One day after this medication change, red rashes with pruritus appeared on his shoulder, neck, and chest. Three days later, his rash increased over large area of her skin, with confluence to sheetlike fashion. Red maculopapules occurred on back and inner side of the thighs which progressed to involve his both shanks and feet. Imipenem/cilastatin sodium was withdrawn and switched to an IV infusion of piperacillin sodium/tazobactam sodium 4.5 g 8hourly. No new rashes occurred ever since. However, his skin lesions continued to progress. He developed exfoliation, and sheetlike desquamation occurred. After symptomatic and supportive treatments, his skin symptoms improved.
  • 病例报告
    Unconsciousness due to transdermal fentanyl patches
    Yi Shuzhen
    2010, 12(6): 433-2.
    Abstract ( ) PDF ( )
    A 59 yearold woman with breast cancer received a patch of transdermal fentanyl (8.4 mg) for back and loin pain control. Thirty minutes later, she fall asleep and, about 4 hours later, she became unconscious accompanied with head backwards position, stiffness of neck, tetany, bilateral miosis, a sluggish papillary light reflex, and a slow respiratory rate (6-7 breaths/min); her SpO2 decreased to 0.77. The abovementioned adverse reactions were considered to be related to fentanyl overdose. The patch of transdermal fentanyl was removed immediately. Oxygen inhalation and IV naloxone 0.2 mg were given. Subsequently, the patient’s tetany relieved and her respiratory rate increased to 18 breaths/min. She regained consciousness and there was no abnormality in her sensory and motor functions.
  • 病例报告
    Thrombocytosis induced by rivaroxaban
    Yuan Yuan;Li Jianjun;Chen Siyuan;Du Liangjie
    2010, 12(6): 435-1.
    Abstract ( ) PDF ( )
    A 16yearold boy was undergone a surgery for thoracolumbar vertebra fracture. After operation, he received rivaroxaban 10 mg once daily. His platelet count was 230×109/L before drug administration. However, eight days later, his platelet count increased to 713×109/L. Rivaroxaban was discontinued and changed to SC nadroparin calcium 4 100 IU every 12 hours. His platelet count decreased gradually. Nineteen days later, his platelet count was 284×109/L.
  • 病例报告
    Decreased fibrinogen caused by omeprazole
    Qian Jun;Ning Feng;Wang Jingwen
    2010, 12(6): 436-1.
    Abstract ( ) PDF ( )
    A 60yearold woman with malignant lymphoma received combined chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednison. Her fibrinogen levels were 2.613.73 g/L in previous six cycles of chemotherapy. Before the seventh chemotherapy cycle, the patient was given an IV infusion of omeprazole 40 mg once daily for gastrointestinal hemorrhage. On day 11 of drug use, she had a fibrinogen level of 0.42 g/L and a positive plasma protamine paracoagulation. Omeprazole was stopped and fresh frozen plasma 400 mL/d was given for two days. On day 6 after discontinuation, the fibrinogen level returned to 2.61 g/L and plasma protamine paracoagulation test was negative. Subsequently, her fibrinogen levels ranged from 1.54 to 2.70 g/L.
  • 病例报告
    Compound paracetamol and phenylephrine tabletsinduced exfoliative dermatitis drug eruption in a young child
    Zhou Meishan
    2010, 12(6): 437-2.
    Abstract ( ) PDF ( )
    A 3yearold boy was given one tablet of compound paracetamol and phenylephrine tablets (each tablet contains paracetamol 125 mg, phenylephrine hydrochloride 2.5 mg, chlorpheniramine maleate 1 mg, vitamin B11 mg ) thrice daily by his mother for his cold. Two days later, he developed red eruption around nose. Subsequently eruption progressed to involve his entire body, and partial eruption progressed to development of ulceration with purulent secretion, and then exfoliation occurred. Laboratory tests revealed a WBC count of 14.3×109/L with 0.086 eosinophils. The patient received symptomatic and supportive treatments for 16 days, and then his symptoms relieved.
  • 病例报告
    Olanzapineinduced atypical neuroleptic malignant syndrome
    Qiu Xiaoyana;Qi Weilinb;Wang Dayoua
    2010, 12(6): 438-2.
    Abstract ( ) PDF ( )

    A 73yearold schizophrenic woman received chlorpromazine (150 mg in morning, 100 mg at night) and benzhexol (4 mg twice daily) for 30 years. Olanzapine 10 mg twice daily was added to the regimen. Two months later, the patient presented with creatine kinase elevation, acheiving a level of 15 570 U/L, and accompanied by fever, hypermyotonia, tachycardia and a pulse of 105 beats/min. Olanzapine was withdrawn and chlorpromazine and benzhexol were continued, meanwhile symptomatic and supportive treatments were given, her creatine kinase level gradually decreased close to normal level. On day 19 after drug discontinuation, the patient selfmedicated with olanzapine 10 mg once daily, the creatine kinase level increased again, acheiving a level of 700 U/L, and then normalized after drug discontinuation.

  • 病例报告
    Acute interstitial nephritis caused by amoxicillin/sulbactam in 2 elderly patients
    Xu Ruiling;Wu Guoxian
    2010, 12(6): 440-2.
    Abstract ( ) PDF ( )
    Two elderly women, aged 80 and 74 years, received an IV infusion of amoxicillin/sulbactam 6.0 g in 0.9% sodium chloride 250 mL once daily for acute attack of chronic bronchitis and skin infection, respectively. Patient 1 experienced urinary frequency, urodynia, dysuria, gross hematuria and 24hour urine volume was about 400 mL the next day. Laboratory tests showed the following values: urine protein (+), occult blood (+++), BUN 8.48 mmol/L, SCr 380 μmol/L. Amoxicillin/sulbactam was stopped and changed to lincomycin. Renal function protective, symptomatic, and supportive treatments were also given. Fifteen days later, her 24hour urine volume was 1 500 mL, her BUN level was 5.86 mmol/L, her SCr level was 116 μmol/L, and routine urine tests were normal. Patient 2 was presented with nausea, vomiting, lumbago, hematuria, three+urine protein and two+occult blood after infusion completion. Amoxicillin/sulbactam was withdrawn and switched to lincomycin. Her conditions did not resolve and 24hour urine volume was less than 200 mL. Her BUN level was 11.45 mmol/L and SCr level was 467 μmol/L. Hemodialysis was performed, lincomycin was continued and supportive and symptomatic treatments were given. Ten days after treatments, her urine volume increased gradually. Twentytwo days later, the 24hour urine volume was 1 200 mL. Meanwhile BUN level and SCr level were respectively 7.83 mmol/L and 141 μmol/L, routine urine tests was within normal range.
  • 病例报告
    Oral ulcer induced by standard heparin
    Zhang Yumeia;Wang Hujunb;Liu Hongtaoa;Wang Yapinga;Zhu Jinga
    2010, 12(6): 441-2.
    Abstract ( ) PDF ( )
    An 80yearold woman with uremia underwent hemodialysis and received an initial dose of standard heparin 24 mg and then a maintenance dose of 5.2 mg/h lasting 3.5 4 hours. Fifteen months later, the patient developed oral ulcer. The symptoms worsened gradually and then ulcer pain and dysphagia appeared. Meanwhile she presented with a 5 mm×8 mm ulcer on the right side of her tongue and a 7 mm×9 mm ulcer in her right oral cavity mucous membranes. Standard heparins was withdrawn and switched to low molecular weight heparin 3 000 IU. Her symptoms relieved. Three days later, she underwent hemodialysis and received standard heparin again and her ulcer then aggravated. Subsequently, standard heparin was changed to low molecular weight heparin again and her ulcer markedly improved but did not heal. And the anticoagulant heparin used for sealing tube was replaced with urokinase. Her ulcer healed completely and did not recur.
  • 病例报告
    Anaphylactic shock associated with topical application of chitosan on operative wound
    Yan Nuo
    2010, 12(6): 442-2.
    Abstract ( ) PDF ( )
    A 10yearold boy received topical application of 1.5% chitosan 5 mL on the surfaces of the intestinal tract and peritoneum for preventing postoperative intestinal adhesion during undergoing appendectomy. After surgery, the boy developed urticaria on his chest and abdomen and, 5 minutes later, his urticaria progressed to involving his entire body, followed by facial edema, shortness of breath, a BP of 50/30 mm Hg, and a pulse rate of 165 beats/min. Anaphylactic shock was considered to be related to chitosan. Adrenaline, methylprednisolone and calcium gluconate were given immediately and, five days later, the boy recovered and was discharged.
  • 病例报告
    Supraventricular tachycardia related to compound paracetamol and chlorphenamine maleate granules
    Chen Huiyun
    2010, 12(6): 444-2.
    Abstract ( ) PDF ( )
    A 52yearold male patient selfmedicated with 2 bags of the compound paracetamol and chlorphenamine maleate granules (each bag contains paracetamol 250 mg, caffeine 15 mg, chlorphenamine maleate 3 mg, calculus bovis factitious 10 mg ) for a cold. Thirty minutes later, the patient developed palpitation, weakness, generalised tremor, and polyhidrosis. His heart rate was 192 beats/min and ECG showed supraventricular tachycardia. He then was given an IV push of propafenone 70 mg. About ten minutes later, the tremor stopped. His symptoms improved gradually and heart rate was 92 beats/min. He did not take compound paracetamol and chlorphenamine maleate granules any more at 3month followup, and the abovementioned symptoms did not recur.
  • 病例报告
    Hyperkalemia associated with irbesartan and candesartan cilexetil
    He Yonga;Xu Xiuyunb
    2010, 12(6): 445-2.
    Abstract ( ) PDF ( )
    A 76yearold women received nimodipine,clopidogrel, 　troxerutin, and oxiracetan for treating acute cerebral infarction and essential hypertension. On hospital day 3, irbesartan 0.15 g once daily was added to her regimen in an attempt to control her hypertension. After 7 days of treatment, her BP was 125/60 mm Hg and her condition improved, and then she was discharged. After discharge, she continued to take clopidogrel, nitredipine, nimodipine, hydrochlorothiazide, and irbesartan. On day 5 after discharge, she had an examination in the outpatient clinic and her renal function tests showed BUN 14.42 mmol/L, SCr 114.0 μmol/L, potassium 6.89 mmol/L, BP 150/70 mm Hg. She was diagnosed with hyperkalemia and hospitalized again. She underwent diuresis and potassium elimination. The increased serum potassium level was considered to be related to antihypertensive agents, and then irbesartan and nitrendipine were discontinued and changed to controlledrelease nifedipine 30 mg once daily. Three days later, her serum potassium level and renal function normalized, and she was discharged. A review of her history showed that, about one year earlier, she had received candesartan cilexetil and had developed increased serum potassium levels.
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