2010 Volume 12 Issue 4 Published: 28 August 2010

  

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临床论著

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  临床论著

  Comparison of anesthetic effectiveness and safety of sevoflurane inhalation anesthesia with laryngeal mask and ketamine intravenous anesthesia in non-hospitalized children undergoing eye surgery

  Lin Na;Li Tianzuo**;Lin Hong;Zhang Bingxi

  2010, 12(4): 229-5.

  Abstract ( ) PDF ( )

  Objective: To observe postoperative recovery and adverse reactions after application of sevoflurane inhalation anesthesia with laryngeal mask and ketamine intravenous anesthesia in ambulatory children undergoing eye surgery in order to compare the anesthetic effectiveness and safety of the two different types of anesthetic agents. Methods: Two thousand seven hundred and seventythree children aged from 4 months to 14 years undergoing cataract, glaucoma, strabismus, ophthalmoplasty, retina, or corneal surgeries at Beijing Tongren Hospital from January to December 2008 were divided into the following two groups: the sevoflurane inhalation anesthesia with laryngeal mask group (the sevoflurane group, n=1 074) and the ketamine intravenous anesthesia group(the ketamine group, n=1 699). The sevoflurane group comprised 698 boys and 376 girls with average age of (4.0±3.0) years. The ketamine group comprised 1 056 boys and 643 girls with average age of (5.4±3.0)years. The children in sevoflurane group received sevoflurane inhalation by mask, and its concentration was increased from 5% to 8% with an oxygen flow rate of 5 L/min. After the patients lost consciousness, venipuncture was established and then the laryngeal mask was inserted, and sevoflurane 1.5%-2.5% was given for maintenance anesthesia during the surgery. The children in the ketamine group received ketamine 2 mg/kg in 10 mL of 0.9% sodium chloride injection intravenously after venipuncture was established, and ketamine 0.5-1.0 mg/kg was given intermittently for maintenance anesthesia during the surgery. Aldrete Scores, PACU length of stay, and adverse reactions during intraoperation period were recorded and analyzed. Results: The children having a score of 10 were discharged from PACU. The length of PACU stay of patients was (23.6±16.1) min and (56.2±34.9) min in the sevoflurane and ketamine groups, respectively. The difference was statistically significant (P<0.01). There was no significant difference in length of PACU stay of patients undergoing different types of surgeries in the sevoflurane group (P>0.05). While the length of PACU stay of patients undergoing phacoemulsitication, intraocular lens implantation, and ophthalmoplasty was shorter than that of patients undergoing strabismus surgery. The difference was statistically significant (P<0.05). Ninety percent of patients in the sevoflurane group developed tachycardia which normalized within 10 seconds during induction of anesthesia. Six patients’SpO2 in the ketamine group was less than 92% during surgery. The incidence of postoperative agitation was 47.6% (511 cases) and 39.8% (676 cases) in the sevoflurane and ketamine groups, respectively. The incidence of nausea and vomiting was 8.4% (90 cases) and 10.2% (173 cases) in the sevoflurane and ketamine groups, respectively. The difference was not statistically significant (P＞0.05). Conclusion: Sevoflurane inhalation anesthesia with laryngeal mask has higher anesthetic effectiveness, more rapid recovery after surgery, and has less adverse reactions compared with ketamine intravenous anesthesia; and it is suitable for non-hospitalized children undergoing eye surgery.
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  临床论著

  Clinical studies on efficacy and safety of lauromacrogol 400 for the treatment of varicose veins of the lower extremities

  Cui Shijun;Zhang Jian;Gu Yongquan;Yu Hengxi;Li Jianxin;Wang Zhonggao

  2010, 12(4): 234-6.

  Abstract ( ) PDF ( )

  Objective: To assess the efficacy and safety of lauromacrogol 400 for the treatment of varicose veins of the lower extremities. Methods: A prospective, randomized, doubleblind trial was conducted. Ninety six outpatients from March 2008 to March 2009 in Xuanwu Hospital of Capital Medical University were selected into the phase Ⅱ clinical trials investigating the treatment of varicose veins of the lower extremities with lauromacrogol 400. Of them, 5 patients were males and 91 were females with an average age of (46±10) years. The varicose veins were classified into spider veins, reticular veins, and medium to largesized veins according to the types. Each type of varicose veins comprised 32 patients, which were allocated in a ratio of 3:1 into the treatment group (24 cases) and control group (8 cases), respectively. The patients with spider veins, reticular veins, and medium to largesized veins in the treatment group were injected with 0.5%（0.1-0.2 mL）, 1% (0.1-0.3 mL), 3% (0.5-2.0 mL) lauromacrogol 400 into their varicose veins, respectively; and the patients in the control group received the same volume of water for injection, respectively. The patients received 1 to 3 treatment courses, and each course was 2 to 4 weeks. The main criterion for efficacy (improvement of varicose veins) and the secondary criterion for efficacy (patients’satisfaction), adverse reactions were observed; efficacy and safety of the drug were assessed. Results: Eighty-eight patients completed the trial, and 8 was lost during the trial. The response rates in the patients with spider veins, reticular veins, and medium to largesized veins in the treatment group were 87.0%, 95.2%, and 82.6%, respectively; and 0, 14.3%, and 0 in the control group, respectively. The differences were statistically significant in comparison of the corresponding values between the treatment and control groups (all P<0.05). The scores of patients’satisfaction in the treatment group were 4.43±1.16, 4.75±0.44, and 3.58±1.44, respectively; and 2.33±0.82, 2.43±1.13, and 2.25±0.71 in the control group, respectively. The differences were statistically significant in comparison of the corresponding values between the treatment and control groups (all P<0.05). The scores of safety assessment in the treatment group were 4.87±0.34, 4.70±0.47, and 4.28±0.90, respectively; 4.67±0.52, 4.90±0.01, and 4.88±0.36 in the control group, respectively. The differences were not statistically significant in comparison of the corresponding values between the treatment and control groups (all P>0.05). The incidence rate of adverse reactions in the treatment and control groups were 37.5% and 25.0%, respectively. The difference was not statistically significant between the treatment and control groups (P>0.05). Conclusion: Lauromacrogol 400 injection is an effective and safe drug for the treatment of varicose veins of the lower extremities.

病例报告

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  病例报告

  Foscarnet sodium-related epileptic seizures and renal damage

  Ren Xiaolei;Huang jing;Li Yuzhen

  2010, 12(4): 239-2.

  Abstract ( ) PDF ( )

  A 18-year-old man underwent hematopoietic stem cell transplantation for acute T lymphoblastic leukemia. On day 22 transplantation,the patient received an IV infusion of cyclosporine 25 mg twice daily and, 5 days later, the dose was increased to 35 mg twice daily, and meanwhile an infusion of foscarnet sodium 3 g twice daily was given. On day 20 of therapy, the patient developed nausea, vomiting, gaze in both eyes, and no response to voice stimuli accompanied by convulsions in limbs and loss of consciousness. His serum creatinin level increased to 129 μmol/L. Phenobarbital used for sedation, mannitol used for dehydration, and other symptomatic treatments were given. After foscarnet sodium was discontinued and cyclosporine dose was decreased to 25 mg every 12 hours, his epileptic seizures did not recur and the serum creatinine level returned to within normal range.

临床论著

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  临床论著

  Effects of CYP2C9 gene polymorphisms and age in Chinese Han patients on warfarin dose

  Liu Yan;Zhang Jian

  2010, 12(4): 240-6.

  Abstract ( ) PDF ( )

  Objective: To investigate the effects of cytochrome P450 (CYP) 2C9 gene polymorphisms and age in Chinese Han patients on warfarin dose in order to benefit warfarin dose adjustment. Methods:Between April 2008 and March 2009, 161 inpatients at stabilized status on warfarin therapy from Beijing Friendship Hospital of Capital Medical University entered the study. The patients were divided into the following two groups: the elderly group and the adult group. The elderly group comprised 55 male patients and 45 female patients with average age of (72±6) years. The adult group comprised 34 male patients and 27 female patients with average age of (49±8) years. Warfarin dose, International Normalized Ratio (INR), cases of overanticoagulation and bleeding, the duration of warfarin treatment achieving the steady doseeffect relationship were recorded. The CYP2C9 gene types in patients in both groups were measured using ABI 3700 DNA sequencer. Maintenance dose of warfarin, the incidence of overanticoagulation in the initiatial period of warfarin treatment, the incidence of bleeding, the time achieving the steady doseeffect relationship were compared between patients with different genotypes and ages. Results:There were no significant differences in distribution of CYP2C9 AA and AC genotypes between the adult and elderly groups (P>0.05). The maintenance doses of warfarin were markedly lower in patients with AC genotype than in those with AA genotype [(2.40±0.96) mg vs (2.73±0.65) mg, P<0.01]; the warfarin maintenance dose in patients with AA and AC genotypes were markedly lower in the elderly group than in the adult group[(2.47±0.48) mg vs (3.24±0.85) mg，(2.08±0.71) mg vs (2.72±1.04) mg, both P<0.01]. During the initiatial period of warfarin treatment, the incidence rate of overanticoagulation was markedly higher in patients with AC genotype than in those with AA genotype (35.0% vs 5.7%, P<0.01); the incidence rate of overanticoagulation in patients with AA genotype was markedly higher in the elderly group than in the adult group (9.3% vs 0, P<0.05). The incidence rate of bleeding was markedly higher in patients with AC genotype than in those with AA genotype (30.0% vs 5.0%, P<0.05); the incidence rate of bleeding in patients with AA genotype was markedly higher in the elderly group than in the adult group (8.1% vs 0, P<0.05). The time achieving stable doseeffect relationship was markedly longer in patients with AC genotype than in those with AA genotype[(21.4±3.2)d vs (10.0±3.5)d, P<0.01]; there was no statistically significant difference in the patients with same genotype between the elderly group and the adult group. Conclusion:The CYP2C9 gene polymorphisms and age in Han Chinese patients can affect warfarin dose. The result from a measurement of CYP2C9 gene polymorphism could be used as a basis for warfarin dose adjustment.
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  临床论著

  Clinical study on antibacterialassociated diarrhea in hospitalized patients

  Xia Jinghong;Liu Haibo;Liu Shuang*;Wang Lingyan;Wang Wenjing

  2010, 12(4): 246-5.

  Abstract ( ) PDF ( )

  Objective: To discuss the occurrence and risk factors of antibacterialassociated diarrhea(AAD) in hospitalized patients in order to provide rational antibacterial use for reference. Methods: Between December 1, 2008 and November 30, 2009, the data of patients with diarrhea from Beijing Anzhen Hospital, Capital Medical University were collected. According to their medical history and stool tests, the patients were divided into two groups: the antibacterialassociated diarrhea group (the AAD group) and the nonantibacterialassociated diarrhea group (the nonAAD group). The clinical characteristics of patients, the situation of the antibacterial use, and the medical intervention measures were compared between the two groups; and the risk factors related to AAD were analyzed. Results: A total of 297 patients with diarrhea entered this study. The AAD group (n=194) comprised 101 male patients with average age of (69±14) years and 93 female patients with average age of (70±16) years. The nonAAD group (n=103) comprised 63 male patients with average age of (61±13) years and 40 female patients with average age of (65±12) years. The rates of patients with age of ≥60 years，number of ICU cases, ≥21 days of a hospital stay, number of a fasting regimen, receiving medical interventions and intensive nursing care,were more in the AAD group than in the nonAAD group.They were 81.4% (158 cases) vs 69.9%(72 cases),47.4% (92 cases) vs 35.9%(37 cases), 37.1%(72 cases) vs 19.4% (20 cases), 49.0% (95 cases) vs 33.0% (34 cases), 30.4% (59 cases) vs 14.6% (15 cases) and 43.3% (84 cases) vs 28.1% (29 cases),respectively (all P＜0.05). The rates of patients receiving antibacterial treatment＞14 days and /or ≥2 antibacterial agents combined were more in the AAD group than in the nonAAD group. They were 43.3% (84 cases) vs 20.4% (21 cases ),84.0% (163 cases) vs 53.4% (55 cases), respectively (all P＜0.01). The antibacterial agents frequently implicated in AAD were cephalosporins, cephamycins, compoundlactamase inhibitors, carbapenems, quinolones, and lincomycin. There was no statistically significant difference in the prognoses between the two groups. The risk factors for AAD included age of ≥60, medical interventions, ＞14 days of antibacterial use, combined antibacterial therapy. Conclusion: Antibacterialassociated diarrhea is one of the common diarrhea in hospitalized patients. Therefore, long time antibacterials use and/or multiple antibacterial use should be avoided. Care should be taken in clinical use of antibacterial for the patients with advanced age, underlying diseases, and underlying fasting regimen and/or medical interventions.

调查研究

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  调查研究

  Cinepazide-induced hematological adverse reactions: review and analysis

  Yi Zhanmiao;Liu Fang*Zhang JunLi XiaoguangZhai Suodi

  2010, 12(4): 251-4.

  Abstract ( ) PDF ( )

  Objective: To investigate the clinical characteristics of hematological adverse reactions induced by cinepazide in order to prevent their development. Methods: Cinepazide, adverse reaction, leucopenia, agranulocytosis, and thrombocytopenia were selected as the searchwords and PubMed(1948-2010),EMBASE (1966-2010), CBM(1978-2010), CNKI(1979-2010), VIP(1979-2010),WANFANG DATA(1989－2010) as well as Adverse Drug Reaction Monitoring Network of Beijing were searched. The literatures and the case reports of hematological adverse reactions induced by cinepazide were collected. The data were analyzed retrospectively, including characteristics of patients, drug use, as well as types, onset time, clinical manifestations, treatment and prognosis to adverse reaction. Results: A total of 14 clinical research papers and the adverse drug reaction reports were selected , 16 patients were enrolled in this study. They comprised 8 men and 8 women with average age of (73.0±11.9) years. The primary diseases were cerebral infarction (9 cases), cerebral hemorrhage (3 cases), peripheral arterial embolism (3 cases) and vertebrobasilar arterial insufficiency (1 case). Dosages of cinepazide were 160 mg/d (2 cases), 240 mg/d (2 cases), 320 mg/d (8 cases), 600mg/d (1 case) and 1 200 mg/d (3 cases), respectively. The onset time to adverse reaction induced by cinepazide was within 5 days (7 cases), 6 to 10 days (3 cases), 11 to 15 days (1 case) and more than 15 days (5 cases) after treatment, respectively. The initial symptom of adverse reactions in most patients was fever. There were 10 patients with leucopenia, 4 with agranulocytosis, 1 with thrombocytopenia and 1 with both leucopenia and thrombocytopenia，in total of 16 patients. Fifteen patients received the drug discontinuation and symptomatic treatment, 14 patients improved and 1 died. Another patient’s drug was not withdrawn. Conclusion: Cinepazide is liable to decrease leckocyte, franulocyte, and platelet. Clinical cinepazide use should be followed by a careful hematological monitoring.

安全用药

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  安全用药

  Safety and adverse events of immunization

  Du Liping;Mei Dan

  2010, 12(4): 255-7.

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  Immunization is one of the most important ways to prevent and control infectious diseases. An increase in vaccine use would lead to more adverse events following immunization (AEFI). The Chinese Center for Disease Control and Prevention classified AEFI into 7 categories: general reaction, unusual reaction, vaccine quality event, program error event, coincidental event, psychogenic reaction, and reaction of unknown cause. The adverse reactions after vaccination of Hepatitis B vaccine, bacille CalmetteGuerin vaccine, oral polio vaccine, measlesmumpsrubella vaccine, pertussisdiphtheriatetanus triple vaccine, Japanese encephalitis vaccine, haemophilus B conjugate vaccine, rabies vaccine, and influenza A (H1N1) vaccine and monitoring and management of AEFI were discussed, so as to provide reference for enhancement of the safety of immunization

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  安全用药

  Treatment and prevention of antibioticassociated colitis: a glimpse of the progress of study

  Li Dan;Ren Aimin;Wang Hong

  2010, 12(4): 262-7.

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  ABSTRACT Antibioticassociated colitis (AAC) mainly occurs 3 to 14 days after the initiation of antibiotic treatment. The incidence among inpatients is 3%29%. The underlying pathological change of AAC is imbalance of intestinal flora caused by application of broadspectrum antibiotics. The pathogenesis mechanism is that antibiotics suppress the normal intestinal flora, and then excessive growth of pathogenic and resistant bacteria occurs. The main pathogenic bacterium is Clostridium difficile(CD)，which produces toxin A and toxin B that injure the intestinal mucosa, make mucin leak, and eventually cause diarrhea. Except CD, methicillin resistant Staphylococcus aureus (MRSA) and Klebsiella species are also pathogenic bacteria of AAC. According to the clinical manifestations，AAC can be divided into three types: mild type characterized by watery diarrhea, severe type by yellow or light green watery diarrhea, abdominal pain, fever, and elevated white blood cells, and fulminant type by diarrhea, high fever, dehydration, hypoproteinemia, toxic shock, intestinal paralysis, even acute intestinal perforation. After the diagnosis of AAC is confirmed, the drugs being in use should be withdrawn immediately. Treatment of metronidazole and vancomycin for 7-10 days can be given, and probiotics can be utilized in addition. For the recurrent cases, vancomycin can be used at a dosage of 125 mg in a regressive manner, and combined with human immune globulin therapy. In order to prevent AAC，the drug indication for antibiotics should be strictly controlled clinically. When the use of broadspectrum antibiotics are neccessary, the intestinal barrier function and normal flora should be monitored. Glutamine and arginine can be added to improve the intestinal immune function.

病例报告

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  病例报告

  Ceftriaxone sodium-related biliary pseudolithiasis

  Zhang Songzhen;Wang Jimei

  2010, 12(4): 268-2.

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  A 48yearold woman with intervertebral disk hernia and right arm pain received an IV infusion of ceftriaxone sodium 3 g once daily, dispersible nimesulide 0.1 g，twice daily and 2 compound chlorzoxazone tablets, three times daily. Five days later, the patient presented with nausea, vomiting and abdominal pain. Ceftriaxone sodium was discontinued. She was given mosapride and weiyankeli for 4 days with no improvement. The patient was hospitalized for abdominal pain. Abdominal ultrasonography showed 1.8 cm×0.9 cm echo-dense sand-like calculi in her gallbladder. No intra- or extrahapatic bile duct dilatation was seen. Cholecystolithiasis was considered to be related to ceftriaxone sodium. The patient received symptomatic treatment of antacid and spasmolysis. After seven days of the treatment, her calculi decreased in size and then she was discharged. One month later, no calculi were detected on repeat ultrasound examination.

安全用药

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  安全用药

  Linezolid-induced lactic acidosis: prevention and treatment

  Lu Meihua

  2010, 12(4): 269-4.

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  Linezolid is an oxazolidinone antibacterial widely used for the treatment of infections caused by vancomycinresistant enterococci and meticillinresistant staphylococcus aureus. The patients may developed increased blood lactate level, even lactic acidosis 1-16 weeks after linezolid administration. The clinical presentations are nausea, vomiting, diarrhea, tachycardia, and mental confusion. The mechanism of lactic acidosis induced by linezolid may be related to inhibit mitochondrial protein synthesis. The measures of prevention and treatment are as follows: the blood lactic acid should be monitored during linezolid treatment; if the blood lactate level is higher than the normal value, the drug should be discontinued; the patient with severe lactic acidosis should be given symptomatic treatment; linezolid combined with SRRIs should be avoided.

中毒救治

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  中毒救治

  Acute liver failure resulting from toadstool poison in three patients

  Lü Fangfanga;Li Guoqianga;Lu Gangb;Yang Boc

  2010, 12(4): 273-3.

  Abstract ( ) PDF ( )

  Three patients (2 men and 1 woman), aged 14, 4, 37 years, took wild mushrooms picked by themselves. One day later, the 3 patients presented with nausea, vomiting, abdominal pain, diarrhea and other gastrointestinal symptoms. The abovementioned symptoms did not relieve after treatments, and liver and cardiac muscle damage occurred. Four days later, the three patients experienced yellowish skin and sclera. Meanwhile the laboratory tests revealed ALT 1 101-6 580 U/L, AST 715-1 965 U/L, TBil 38.5-153.2 μmol/L, DBil 16.9-63.1 μmol/L, IBil 21.6-90.1 μmol/L, LDH 1 036-2 234 U/L, CK-MB 18-36 U/L, CK 30-669 U/L. Toxic mushroom poisoning and liver failure were diagnosed. The three patients were given with albumin dialysis, plasmapheresis, and symptomatic and supportive treatments. The patients’condition improved and were discharged after 14 days of hospitalization.

病例报告

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  病例报告

  Death from disseminated intravascular coagulation caused by anaphylaxis due to phosphonomycin

  Guo Yuzhi;Miao Shuxia;Wang Fengzhi;Tian Yin

  2010, 12(4): 275-2.

  Abstract ( ) PDF ( )

  A 51yearold male patient received IM compound aminophenazone and barbital injection 2 mL for fever and chill. One hour later, an IV infusion of phosphonomycin 4 g in 5% glucose 250 mL was given due to poor efficacy. During the infusion, the patient developed chest distress, shortness of breath, and the symptom of chill was aggravated. Subsequently, phosphonomycin was withdrawn and promethazine, adrernalin, dexamethasone, and dextran were given. However, the symptoms did not improve and the patient experienced dyspnea. The next day, he presented with marked cyanosis in the face and whole body skin with massive ecchymosis, palpebral edema, conjunctival congestion, and cool clammy extremities. Moist rales were heard in both lungs. Laboratory examination showed a PLT level of 45×10⁹/L, a prothrombin time of 37.3 s, an activated partial thromboplastin time of 78.1 s，and a D-dimer level of 1 600-3 200 μg/L. Finally, he died despite resucitation efforts.

中毒救治

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  中毒救治

  Acute renal failure associated with amoxicillin overdose

  Li Qing;Lei Zhaobao

  2010, 12(4): 276-2.

  Abstract ( ) PDF ( )

  A 44yearold woman started receiving an IV infusion of amoxicillin 6 g dissolved in 500 mL of 0.9% sodium chloride once daily for preventing infection 5 days before undergoing hysteromyomectomy. On day 6, the patient developed hematuria 15 minutes after surgery, and serum creatinine level was 140.99 μmol/L. Acute renal failure was considered to be related to amoxicillin overdose. Amoxicillin was discontinued and switched to cefotaxime and mezlocillinsulbactam. Meanwhile she was given furosemide, pantoprazole. On day 14 after surgery, the patient’s renal function returned to normal.
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  中毒救治

  Lactic acidosis resulting from phenformin overdose

  Liao Qiuju;Wang Jing;Xing Xiurong;Qin Jian;Wang Changyuan

  2010, 12(4): 278-2.

  Abstract ( ) PDF ( )

  A 24yearold woman took 70 tablets of phenformin 25 mg. One day later, the patient experienced vomiting, abdominal pain, diarrhea, dyspnea, delirium, agitation, unconsciousness, and no response to voice stimuli. Her blood pressure was 70/39 mm Hg and heart rate was 114 beats/min. The laboratory examinations revealed the following levels and values: glucose 0.06 mmol/L, lactic acid 32.51 mmol/L, SCr 169 μmol/L, pH 6.89, PCO₂ 20 mm Hg, PO₂ 71.2 mm Hg, SaO₂ 0.913, BE -19.8 mmol/L, and HCO₃^- 16.5 mmol/L. She was given an IV push of 50% glucose 40 mL, and an IV infusion of 5% sodium dicarbonate 250 mL, fluid supplementation, ventilator support, hemofiltration, and other treatments. Four days later, the patient returned to normal consciousness and spontaneous respiration and, 10 days later, she recovered and was discharged.

病例报告

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  病例报告

  Acute liver damage induced by antithymocyte globulin in a child

  Jing Hua

  2010, 12(4): 279-2.

  Abstract ( ) PDF ( )

  A 17monthold male child with type 1 diabetes was hospitalised for undergoing autologous hematopoietic stem cell transplantation. After admission, he was given SC filgrastin 5.0 μg/kg for hematopoietic stem cell mobilization followed by cyclosporine 25 mg twice daily, on day 12, his liver function was normal. Cyclosporine was stopped and changed to an IV infusion of antithymocyte globulin 8 mg on first day and 12 mg on second day. Subsequently, biochemical tests revealed the following values: ALT 1 041 U/L, AST 209.3 U/L, ALP 296.4 U/L, LDH 695.1 U/L, TBil 19.3 μmol/L, DBil 11.7 μmol/L. Antithymocyte globulin was withdrawn immediately and liverprotective treatments were given．His liver function improved gradually. Twenty days later，he received hematopoietic stem cell reinfusion and was discharged without discomfort. His liver function was normal at half a year follow-up.
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  病例报告

  Long R-R interval occurring in an elderly patient receining ibutilide for cardioversion of atrial fibrillation

  Wu Yuntao;Chen Yanmei;Cao Jingjing;Bai Xupeng;Lü Mingfang

  2010, 12(4): 280-2.

  Abstract ( ) PDF ( )

  A 77yearold male patient received a slowly IV push of ibutilide 1 mg dissolved in 50 mL of 0.9% sodium chloride for his atrial fibrillation(AF) conversion. After sixteen minutes, AF was converted to sinus rhythm. But he experienced 10 episodes of sinus arrest with the longest R-R interval of 4.872 seconds. The patient did not have dizziness, headache, chest pain, chest discomfort. After AF was successfully converted, the patient continued to take propafenone, metoprol, warfarin without any discomforts.
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  病例报告

  Amiodarone-related pulmonary interstitial fibrosis

  Fan Chun;Wang Ying

  2010, 12(4): 282-3.

  Abstract ( ) PDF ( )

  A 73yearold man with atrial fibrilation received IV infusions of amiodarone 800 mg/d for one week, and then 600 mg/d for one month, 400 mg/d for two months, and 200 mg/d for three months by mouth. After six months, the patient developed dry cough and shortness of breath. CT scan revealed pulmonary interstitial fibrosis in both lungs. Laboratory tests revealed the following levels and values: WBC 22.68×10⁹/L, N 0.76; BUN 11.20 mmol/L, SCr 182 μmol/L; blood pH 7.36; PO₂ 35 mm Hg, PCO₂ 49 mm Hg and SaO₂ 64%. Amiodaronerelated pulmonary interstitial fibrosis with infections was considered.The patient was given oxygen inhalation through a face mask, an IV infusion of levofloxacin 0.5 g once daily, an IV infusion of cefoperazonesulbactam 3.0g twice daily, an IV infusion of methylprednisolone 40 mg twice daily, and acetylcysteine 0.6 g twice daily. On the day 14 of therapy, the man had a severe decrease in pulmonary diffusion capacity, severe hypoxemia ( SaO₂ < 50%), a BUN level of 18.90 mmol/L, a SCr level of 286 μmol/L, and a urine volume of 200 mL/d. On day 21 of hospitalization, his BUN was 24.10 mmol/L and his SCr was 357 μmol/L. The patient's blood pressure decreased markedly with frequent episodes of atrial fibrillation. Finally, the patient died of failure and pulmonary infections.
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  病例报告

  Cefepime-induced neurological adverse reactions in two patients with uremia undergoing hemodialysis

  Wang Zhiqing

  2010, 12(4): 284-3.

  Abstract ( ) PDF ( )

  Two patients (a woman aged 76 years and a man aged 56 years ) with uremia undergoing hemodialysis received an IV infusion of cefepime 1 g every 12 hours for respiratory tract infections, respectively. The woman developed listlessness, unresponsiveness, agitation, followed by agnosia and aphasia on day 5 of treatment, and ECG revealed diffuse slow waves. The man presented with nausea, vomiting, agitation, myocolonia, dysphasia, unresponsiveness, and mental confusion on day 3 of treatment. In addition, brain CT showed no marked change in both patients. Neurological adverse reactions were considered to be related to cefepime. Therefore，cefepime was discontinued and hemodialysis was continued. Subsequently, neurological and mental adverse reactions disappeared and both patients were discharged.
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  病例报告

  Sleep behavior disorders induced by zolpidem in three patients

  Qiu Changa;Jiang Fanb;Kuang Ruyic

  2010, 12(4): 286-3.

  Abstract ( ) PDF ( )

  Three patients with insomnia developed sleep behavior disorders after administration of zolpidem. Patient 1, a 56yearold woman, fell asleep after taking zolpidem 10 mg. One hour later, she walked into kitchen, opened the door of refrigerator, and then ate the food. Thirty minutes later, she went to bed voluntarily. The next day, the patient had no memory of that event. The similar conditions did not recur after zolpidem was decreased to 5 mg. Patient 2, a 23yearold woman, went to sleep after administration of zolpidem 10 mg. About two hours later, her classmate received one short message from the patient’s mobile phone. The second day, she had no memory of that event. The abovementioned symptoms did not recur after zolpidem discontinuation. Patient 3, a 28yearold woman, fell asleep after receiving zolpidem 15 mg. Ten minutes later, the patient experienced soliloquy and cannot recognize her roommate. The next day, she had no memory of the event. The abnormal behavior was not recur after zolpidem discontinuation.
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  病例报告

  Choice of insulin preparation based on skin testing: a case report

  Li Chunlianga;Pan Qib;Guo Lixinb;Ji Liweic

  2010, 12(4): 289-2.

  Abstract ( ) PDF ( )

  A 56yearold woman with diabetes mellitus received human regular insulin about 3 years before hospitalization, and 15 minutes affter injection, the patient developed subcutaneous nodules at injection site with pruritus, which subside spontaneously in 1-4 days, and paroxysaml nocturnal dry cough. Six months before hospitalization, the regimen was instead of human isophane insulin and subcutaneous nodules remained, but dry cough at night disappeared. After admission, laboratory tests revealed eosinophils count of 062×10⁹/L and the rate of eosinophils was 0.69. A IgE level was 96.60 U/mL and IAA examination was positive. On admission, she presented with asthma and the symptoms improved after treatments. The skin testing was performed in order to select an appropriate insulin preparation. Human isophane insulin 10 U once was selected based on the skin testing and acarbose, metformin, and pioglitazone were given. The patient had a well control of blood glucose and developed intermittent small scleroma which was subsided spontaneously, occasional pruritus, and dry cough and asthma did not recur.
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  病例报告

  Norvancomycin-induced agranulocytosis and red man syndrome

  Zhang Yan;Zhang Yunzhou;Su Yingying

  2010, 12(4): 290-3.

  Abstract ( ) PDF ( )

  A 49yearold man with ventilatorassociated pneumonia received etimicin and meropenem. Three days later, sputum culture showed methicillin resistant Staphylococcus aureus (MRSA). Etimicin was withdrawn and then norvancomycin 400 mg dissolved in 0.9% sodium chloride 250 mL was given by an IV pump every 12 hours while meropenem was continued. After 13 days of therapy, the patient developed fever of 39.9 ℃, lamellar red rashes in his neck, chest, abdomen, and back which gradually progressed to involve his body from the neck to both groins. Routine blood tests revealed the WBC count of 1.39×10⁹/L and proportion of neutrophiles of 0.06×10⁹/L. Norvancomycin was withdrawn and cefoperazone sodium and sulbactam sodium was given via an IV pump, while meropenem use was maintained. Meanwhile he was given cimetidine and filgrastim. Four days later, almost all rashes disappeared. Eleven days later, the counts of WBC and proportion of neutrophiles returned to normal. Subsequently, norvancomycin was discontinued and the abovementioned symptoms did not recur and the routine blood examination results were within the normal range.
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  病例报告

  Difficult urination and urinary retenion related to citalopram combined with quetiapine

  Xu Jing;Chen Jie;Luo Ziling

  2010, 12(4): 292-2.

  Abstract ( ) PDF ( )

  A 69yearold woman was hospitalized for chest pain. On day 2 of admission, the patient had poor sleep at night. She received trazodone 50 mg once daily at bedtime and her symptoms did not improve after 4 days of drug therapy. Trazodone was stopped and changed to citalopram 10 mg at bedtime. But the symptoms did not relieve. Depression was diagnosed and she was given concomitant use of citalopram 20 mg and quetiapine 50 mg at bedtime. She developed urinary hesitancy, straining, and decreased urine volume. On day 6, she experienced difficult urination and urinary retenion. Citalopram and quetiapine were withdrawn and she underwent insertion of an urethral catheter. Five days later, her symptoms improved and spontaneous micturition was restored.
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  病例报告

  Hypokalemia associated with felodipine sustained-release tablets

  Zhao Mingxing;Chu Ruixue;Shi Xiaoping;Zhao Kaiming;Zhang Hua

  2010, 12(4): 293-2.

  Abstract ( ) PDF ( )

  A 58yearold man with primary hypertension received felodipine sustainedrelease tablets 5 mg once daily, atorvastatin calcium 10 mg once daily, and vitamin E 0.1 g once daily. Three months later, his blood biochemical tests showed a serum potassium level of 3.11 mmol/L. The patient was given potassium chloride sustainedrelease tablets, and his serum potassium level returned to normal. However, the potassium level decreased again after drug discontinuation, and then he was hospitalized. On admission, his serum potassium level was 3.35 mmol/L. Hypokalemia due to primary aldosteronism was excluded. Felodipine sustainedrelease tablets were withdrawn and switched to irbesartan 0.15 g once daily. Potassium chloride sustainedrelease tablets 0.5 g thrice daily was added to the regimen, and other treatments continued. Two weeks later, his blood biochemical tests revealed a serum potassium level of 4.19 mmol/L. Potassium chloride sustainedrelease tablets were stopped and, one month later, his serum potassium level was 3.85 mmol/L. Subsequently, his serum potassium level was normal on reexaminations.
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  病例报告

  Epidermolysis bullosalike reactions due to ibuprofen

  Xing Dan

  2010, 12(4): 294-2.

  Abstract ( ) PDF ( )

  A 47yearold woman was hospitalized for aggravated symptoms of thrombocytopenic purpura. After admission, she received amifostine and platelet transfusion. On day 11, her temperature was 38.8 ℃ and then she was given ibuprofen 0.05 g. The next day, the patient developed whealandred rash with pruritus in both lower limbs. On day 13, her temperature was 38.9 ℃, the patient was administered ibuprofen 0.05 g again. Subsequently, she presented with red wheal in extremities, chest, and back, and some rashes fusing into lamella in knees and buttocks followed by marked pain in her feet and knees. On day 17, her temperature was 39.5 ℃. After the third administration of ibuprofen 0.1 g, she developed obviously generalised pain and vesicles in her jaw, both upper arms, abdomen, and back. She underwent physical methods for lowering fever and received glucocorticoid and human immunoglobulin. Meanwhile she received symptomatic therapies for vesicles. Her symptoms improved and, on day 21, the laboratory test revealed a PLT count of 151×10⁹/L. She recovered and was discharged after one month of hospitalizaiton.

中药不良反应

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  中药不良反应

  Liver damage induced by Diaoliu pills

  Jiao Lin

  2010, 12(4): 296-2.

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  A 40yearold woman took Diaoliu pills 6 g thrice daily for her hyperplasia of mammary glands. After 5 days of the treatment, the patient developed the upper abdominal discomfort and nausea, followed by vomiting, fatigue and dark urine. Laboratory tests results: ALT 926 U/L，AST 452 U/L，TBil 68.9 μmol/L，DBil 36.5 μmol/L，IBil 32.4 μmol/L. Druginduced liver damage was diagnosed. Diaoliu pills were discontinued and liverprotective treatments were given. After 20 days of hospitalization her clinical symptoms disappeared and all laboratory indices returned to normal.
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  中药不良反应

  Liver damage due to Baishi Pills

  Zhang Qiuling;Yang Jia;Lu Yixia

  2010, 12(4): 297-2.

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  A 59yearold woman received Baishi pills 2.5 g thrice daily for therapy of leucoderma. Two months later, biochemical tests revealed the following values: ALT 394 U/L, AST 171 U/L, γ-GT 63 U/L, ALP 158 U/L, LDH 226 U/L. Baishi pills were stopped and she was given compound glycyrrhizin, inosine, vitamin B₆, and glucurolactone. One week later, her liver function normalized.