2010 Volume 12 Issue 1 Published: 28 February 2010
  

  • Select all
    |

    临床论著

  • 临床论著
    Wang Gang;Liu Aiyong;Gao Wenbin;Wang Wulong;An Hongliang
    2010, 12(1): 1-4.
    Abstract ( ) PDF ( )
    Objective: To explore the clinical safety of weekly singleagent paclitaxel chemotherapy plus three dimensional conformal radiotherapy in treatment of elderly patients with locally advanced nonsmall cell lung cancer(NSCLC). Methods: A multicentre, openlable trial was performed. From January 2006 to December 2008, 56 patients with stage Ⅲ NSCLC were enrolled in this study. They comprised 39 men and 17 women with age of 60~78 years and the mean age was 67 years. These 56 patients included squamous carcinoma (36 patients), adenocarcinoma (20); Ⅲa stage NSCLC (34) and Ⅲb stage NSCLC(22). An intravenous infusion of paclitaxel 40 mg/m2 was given once a week, followed by 3D-CRT(6MV-X ray, 95%PTV/60Gy/2Gy/30f) once daily 3 hours after paclitaxel infusion completion. The duration of treatment was 6 weeks. The changes in primary focus and mediastinal lymphatic metastasis as well as adverse reactions and survival situation were recorded during treatment and in week 2 after treatment completion. Results: All 56 patients completed 6week therapy. The total effective rate to primary focus of NSCLC was 821%(46/56) and the total effective rate to mediastinal lymphatic metastasis was 91.1%(51/56). The total effective rate to primary foci of squamous carcinoma and adenocarcinoma was 88.9%(32/56) and 70.0%(14/20), respectively, and the total effective rate to mediastinal lymphatic metastasis of squamous carcinoma and adenocarcinoma was 97.2%(35/36) and 80.0%(16/20), respectively. There was no statistically significant difference among different types of pathology. Acute adverse reactions to chemotherapy were mainly bone marrow suppression, the incidence of a reduction of white cells, hemoglobin, and platelets were 42.9%(24/56), 51.8%(29/56), and 30.4%(17/56), respectively, and the incidence of nausea and vomiting were 42.9%(24/56). Acute adverse reactions to radiotherapy were mainly radiationinduced esophagitis and pneumonia, and their incidence was 17.9%(10/56) and 58.9%(33/56), respectively. All the adverse reactions mentioned above in the patients with squamous carcinoma and adenocarcinoma were mild. The mean time to disease progression was respectively 7.8 months and 5.6 months, the mean survival time was respectively 11.3 months and 10.2 months, oneyear survival rate was respectively 47.2% and 35.0%, and twoyear survival rate was respectively 25.0% and 15.0%. Conclusion: Weekly singleagent paclitaxel chemotherapy plus 3D-CRT has better shortterm efficacy and safety in treatment of elderly patients with locally advanced NSCLC.
  • 病例报告

  • 病例报告
    Zheng Yi
    2010, 12(1): 4-2.
    Abstract ( ) PDF ( )
    A 79yearold man with bronchiectasia and pulmonary infections was given an IV infusion of teicoplanin 400 mg/d dissolved in 0.9% sodium chloride 250 ml due to poor control of his disease. On second day, the patient experienced exciting, euphoria, coprolalia, delirium, irritability, accompanied by skin itching. On day 3, his mental symptoms aggravated. Teicoplanin was discontinued and, two days later, the abovementioned symptoms subsided.
  • 实验论著

  • 实验论著
    Liu Renhui;Wang Pei;Jin Xihong;Wang Yali;Kang Xue;Wang Xiujuan
    2010, 12(1): 5-5.
    Abstract ( ) PDF ( )
    Objective: To observe the effects of dexamethasone on hypothalamicpituitaryadrenocortical (HPA) axis and bone metabolism in rats with ovalbumininduced asthma at different stages of intervention (before withdrawal, during withdrawal, after withdrawal). Methods:Ninety rats were randomly divided into three groups (30 rats in each group): the normal control group, the asthmatic model group, the dexamethasone intervention group. The rats in each group were redivided respectively into 3 subgroups (10 rats in each subproup) according to the time to be sacrificed (on days 49, 77, and 91). The rat model of asthma was established by ovalbumin (OVA) injection sensitization followed by challenge with gaseous ovalbumin. Dexamethasone intervention group received intraabdominal injection of dexamethasone 0.5 mg/kg from day 35 to day 48 (at the stage before withdrawal). The dose of dexamethasone was decreased by 0.1mg/kg every week from day 49 to day 76 (at the stage during withdrawal). Dexamethasone was stopped on day 77 and observations were carried on until day 90 (at the stage after withdrawal). Gaseous normal saline solution containing 0.1%OVA was inhaled twice a week in the asthmatic model and dexamethasone intervention groups. At all stages of the experiment, the indexes of spleen and adrenal, levels of serum CORT, plasma ACTH, hypothalamic CRH, and plasma BGP were measured. Results:(1) On day 49, in the normal control, asthmatic model, and dexamethasone intervention groups, the spleen indexes were 1.504±0.213, 1.548±0.208, and 1.254±0.239, respectively; the adrenal indexes were 0.132±0.039, 0.108±0.027, and 0.065±0.017, respectively; the levels of CORT were (2 301±628)ng/L, (1 658±486)ng/L, and (235±160)ng/L, respectively; the levels of ACTH were (62.7±17.4)ng/L, (32.7±17.2)ng/L, and (19.7±8.8)ng/L, respectively; the levels of CRH were (5.77±2.01)ng/mg·prot, (4.20±1.87)ng/mg·prot, and (3.40±1.28)ng/mg·prot, respectively; the levels of BGP were (5.22±2.14)μg/L, (3.64±1.40)μg/L, and (0.65±0.62)μg/L, respectively. The levels of ACTH and CRH in asthmatic model group were significantly lower than those in the normal control group (P<0.01 and P<0.05, respectively). The level of CRH in dexamethasone intervention group was significantly lower than that in the normal control group. Other laboratory values in dexamethasone intervention group were significantly lower than those in the normal control and asthmatic model groups. (2) On day 77, in the normal control, asthmatic model, and dexamethasone intervention groups, the spleen indexes were 1.515±0.169, 1.567±0.180, and 1.287±0.380, respectively; the adrenal indexes were 0.112±0.058, 0.100±0.027, and 0.069±0.022, respectively; the levels of CORT were (2 433±379)ng/L, (1 905±410)ng/L, and (355±239)ng/L, respectively; the levels of ACTH were (65.3±31.0)ng/L, (38.4±11.7)ng/L, and (39.6±14.9)ng/L, respectively; the levels of CRH were (5.05±1.62)ng/mg·prot, (4.15±1.39)ng/mg·prot, and (3.04±1.37)ng/mg·prot, respectively; the levels of BGP were (2.63±0.96)μg/L, (2.50±1.20)μg/L, and (0.79±0.53)μg/L, respectively. The level of CORT in the asthmatic model group was significantly lower than that in the normal control group (P<0.01). The indexes of spleen and the adrenal, the levels of CORT, CRH, and BGP in the dexamethasone intervention group were significantly lower than those in the normal control and asthmatic model groups (P<0.05 or P<0.01), except the level of ACTH. (3) On day 91, in the normal control, asthmatic model, and dexamethasone intervention groups, the spleen indexes were 1.463±0.190, 1.786±0.316, and 2.278±0.412, respectively; the adrenal indexes were 0.112±0.021, 0.110±0.020, and 0.093±0.017, respectively; the levels of CORT were (2 627±509)ng/L, (2 318±364)ng/L, and (2 212±400)ng/L, respectively; the levels of ACTH were (63.0±33.5)ng/L, (48.8±19.9)ng/L, and (30.7±19.1)ng/L, respectively; the levels of CRH were (5.39±1.40)ng/mg·prot, (3.80±0.94)ng/mg·prot, and (3.67±1.09)ng/mg·prot, respectively; the levels of BGP were (4.58±2.19)μg/L, (3.21±1.34)μg/L, and (1.93±0.91)μg/L, respectively. The spleen index in the asthmatic model group was significantly higher than that in the normal control group (P<0.01). The CRH level in the asthmatic model group was significantly lower than that in the normal control group (P<0.01). The spleen index in dexamethasone intervention group was significantly higher than that in the normal control and asthmatic model groups. The adrenal index, the levels of ACTH and BGP in dexamethasone intervention group were significantly lower than those in the normal control and asthmatic model groups (P<0.05, P< 0.01). The levels of CORT and CRH in dexamethasone intervention group were significantly lower than those in the normal control group(P<0.05, P<0.01). Conclusion:Dexamethasone has different inhibitory effect on HPA axisrelated indexes at different stages in rats of asthmatic model. It also inhibit the bone metabolism at all stages.
  • 实验论著
    Hu Zhonghui;Wu Chunqi;Wang Quanjun;Wang Qingxiu;Luo Yongwei;Yang Baohua;Lu Shujie;Liao Mingyang
    2010, 12(1): 10-7.
    Abstract ( ) PDF ( )
    Objective: To study the toxic effects of two kinds of Lianbizhi injections on rats in order to provide experimental evidence for the causes of adverse reactions. Methods:Two kinds of Lianbizhi injections were used in this experiment as follows: Lianbizhi A containing andrographolide sodium bisulfis 98.7% and other related substance 1.3%, Lianbizhi B containing andrographolide sodium Bisulfis 49.1% and other related substance 50.9%. Seventy SPF male SD rats were randomly divided into 7 groups: the low-dose (400 mg/kg), moderatedose (800 mg/kg), and highdose (1 600mg/kg) Lianbizhi A groups, the lowdose (50 mg/kg), moderatedose (100 mg/kg), and highdose (200mg/kg) Lianbizhi B groups, and the empty control group (normal saline). Each group comprised 10 rats. All rats received respectively a single intravenous injection of Lianbizhi 10 mL/kg via caudal vein. The presentation of rats was observed within 3 hours after drug administration. The rats’urine was collected within 0~6, 7~12, 13~18 and 19~24 hours after drug administration. The levels and values of acetone bodies, occult blood, BUN, creatinine (Crea), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), N-acetyl-β-D-glucosaminidase (NAG) , and β2 microglobulin (β2-MG) were measured. The blood was collected from rat’s hearts, and the biochemical indexes were measured. Finally, the rats were sacrificed. Their organs were weighed, organ coefficient was calculated, and histopathological changes in the kidney were observed. Results: Two rats in the highdose Lianbizhi B group developed convulsion and erect hair, and they recovered 30 minutes later. No abnormal manifestation was found in rats in other groups. The number of rats having positive ketones in urine[≥(+2)] in high-, moderate-, and low-dose Lianbizhi A groups and highdose Lianbizhi B group was more than that in the control group. The number of rats having positive occult blood in urine[≥(+2)] in the high-, moderate-dose Lianbizhi A groups and high-, moderate-, and low-dose Lianbizhi B groups was more than that in the control group. The BUN levels in the highdose Lianbizhi A group were (319±108) mmol/L before drug administration and increased to (488±139) mmol/L within 7~12 hours after drug administration. The difference was statistically significant (P<0.05). The Crea levels in the high-, moderate-, and low-dose Lianbizhi A groups as well as high- and moderate-dose Lianbizhi B groups were respectively (3 338±1534),(3502±1457),(3428±1 729),(3 305±922),and (3 480±870) mol/L before drug ministration and increased respectively to (6 137±1 544), (5 847±1 319), (5 630±1 622), (5 613±1 968), and (5 218±1 496) mol/L within 7~12 hours after drug administration. The differences were statistically significant (all P<0.05). In addition, the Crea levels in high and moderatedose Lianbizhi A groups were markedly higher than that [(4 326±576) mol/L] in the control group (P<0.05). The increase in Crea levels was related to the dose of andrographolide sodium bisulfis(r=0.790 9). The ALP level in the high-dose Lianbizhi A group was (152±61) U/L within 7~12 hours after drug administration, which was higher than that [(99±37)U/L] in the control group. The ALP level in the high-dose Lianbizhi B group was (143±42)U/L within 7~12 hours after drug administration, which was higher than that [(94±42)U/L] before drug administration and that in the control group. The differences were statistically significant (all P<0.05). The LDH levels in the high, moderate, and lowdose Lianbizhi A groups as well as high-and moderate-dose Lianbizhi B groups were respectively (19±7), (18±11), (18±8), (17±5), and (17±10)U/L before drug administration, and then increased respectively to (88±56), (80±27), (50±17), (57±16), and (28±6)U/L within 0~6 hours after drug administration. The LDH levels in the high-, moderate-, and low-dose Lianbizhi A groups as well as highdose Lianbizhi B groups increased respectively to (44±21), (36±17), (34±13), and (31±7)U/L within 7~12 hours after drug administration. The differences were statistically significant (all P<0.05). In addition, the LDH levels in the high-, moderate-, and low-dose Lianbizhi A groups as well as high and moderatedose Lianbizhi B groups were higher than that [(18±10)U/L] at the same time periods in the control group, the LDH levels in the high-, moderate-, and low-dose Lianbizhi A groups as well as high-dose Lianbizhi B groups were higher than that [(23±7)U/L] at the same time periods in the control group. The differences were statistically significant (all P<005). The increase in LDH levels was related to the dose of andrographolide sodium bisulfis(r=0.899 0). The NAG levels in the high- and moderate-dose Lianbizhi A groups were respectively (0.30±0.04) and (0.31±0.04) U/L within 0~6 hours after drug administration; the NAG levels in the high-, moderate-, and low-dose Lianbizhi A groups were respectively (0.45±0.07), (0.40±0.18), and (0.37±0.14) U/L within 7~12 hours after drug administration; the NAG levels in the high-, moderate-, and low-dose Lianbizhi A groups as well as high-, moderate-, and low-dose Lianbizhi B groups were respectively (0.35±0.09), (0.31±0.06), (0.39±0.18), (0.60±0.09), (0.57±0.06), and (0.33±0.08)U/L within 13~18 hours after drug administration; the NAG levels in the moderate-and low-dose Lianbizhi A groups as well as high-, moderate-, and low-dose Lianbizhi B groups were respectively (0.32±0.03), (0.39±0.14), (0.32±0.07), (0.34±0.05), and (0.29±0.08)U/L within 19~24 hours after drug administration; which were higher than those [(0.26±0.05), (0.22±0.06), (0.24±0.07), and (0.24±0.06)U/L] in the control group. The differences were statistically significant (P<0.05). The β2MG levels in the high-dose Lianbizhi B group was (1.03±0.45) mg/L within 19~24 hours after drug administration, and it was (0.54±0.24)mg/L in the control group; the difference was statistically significant (P<0.05). The increase in NAG and β2-MG levels was associated with the amount of other related substance (r=0.874 9,r=0.981 9). There were no statistically significant differences in biochemical results in rats between the drugexposed groups and the control group. No marked changes in the appearance of rat’s organs, histopathology, and organ coefficient were found. Conclusion: The potential nephrotoxic effects of Lianbizhi injection on rats is related to its purity and dosage; high amount of other related substance and high dosage of the drug could increase renal damage.
  • 实验论著
    Jin Yong; Liu Shumin; Liu Ying; Mou Hong
    2010, 12(1): 17-4.
    Abstract ( ) PDF ( )
    Objective: To study the toxic effects of ethyl acetate, nbutanol, and water extracts from 65% alcohol extractions of cocklebur fruit on liver in rats in order to provide a basis for a further investigation of the toxic constituents of cocklebur fruit (Fructus Xanthii). Methods:Twentytwo kilogram of ground cocklebur fruit was macerated in 8-fold amounts of 65% alcohol for 6 hours, and then was extracted by heating under a reflux condenser for 2 hours. The total number of extracting was two times. The alcohol extractions were combined, and the alcohol were retrieved with vaccum distillation till no smell of alcohol. The extractions were concentrated further. The concentrated solution was extracted with petroleum ether, followed by retrieval of petroleum ether. The extractions were extracted with ethyl acetate and nbutanol in turn. The solvents were retrieved and then the water layer was evaporated to dryness with vaccum evaporator. Four point eight gram of ethyl acetate extracts, 24 g of nbutanol extracts,and 56 g of water extracts were mixed with 2000 mL of normal saline solution containing 3% Tween80, respectively. The concentration of the suspensions were 0.0024, 0.012, and 0.028 g/ml, respectively. Forty SPF male rats were randomly divided into 4 groups and each group comprised 10 rats. The three drugexposed groups were gavaged with 2.5 mL of ethyl acetate, nbutanol, and water extract suspensions twice daily, respectively (the dosage was 0.06 g/kg, 0.3 g/kg, 0.7 g/kg daily, respectively). The empty control group was gavaged with same volume of normal saline solution containing Tween80 twice daily. The duration of gavage was 28 days. The appearance, diet, and activities of rats were observed. The body weight of the rats were weighted before drug administration and 14, 21, and 28 days after drug initiation. On day 29, serum levels of ALT, AST, AKP, TBil, and DBil were measured. Subsequently, the rats were sacrificed and the liver index was calculated and changes in histomorphology were observed. Results: The rats in the water extract group developed lusterless fur and decrease in diet and activities 7 days after drug initiation. The rats in the nbutanol extract group developed lusterless fur and listlessness 14 and 21 days after drug initiation as well as erect hair and lassitude 28 days after drug initiation. The rats in the ethyl acetate extract group had no marked changes. The body weight of rats in the nbutanol extract group were (240.6±24.1) and (255.1±21.3)g 21 and 28 days after drug initiation, respectively. The body weight of rats in the water extract group were respectively (214.2±20.5),(230.7±21.2), and (239.1±18.5)g 14, 21, and 28 days after drug initiation, and their body weight were all lower than that of the rats in the empty control group at the same time points [(251.7±27.2),(280.7±38.2), and(306.2±36.5)g, (P<0.05, P<0.01)]. The AST levels in the nbutanol extract group was(112.6±24.3)U/L, which was marked higher than that [(79.9±20.4)U/L] in the empty control group ( P<0.01). The levels of ALT, AST, and AKP in the water extract group were respectively (51.1±3.9),(112.9±16.6), and (198.4±41.8)U/L, which were marked higher than those [(44.3±6.2), (79.9±20.4) and (152.2±39.9)U/L] in the empty control group (P<0.05, P<0.01). The liver indexes in the ethyl acetate extract and water extract groups were respectively 4.71±0.89, and 5.80±0.64, which were marked higher than that (3.14±0.33) in the empty control group (P<0.01). The levels of TBil and DBil in all the drugexposed groups increased, but there were no statistically significant differences(P>0.05). In the nbutanol extract and water extract groups, the pathological changes such as enlarged hepatic cell space, karyolysis, and inflammatory cell infiltration were observed under the light microscope. Conclusion:The nbutanol extracts and water extracts from alcohol extractions of cocklebur fruit have marked hepatotoxicity to rats.
  • 调查研究

  • 调查研究
    Li Chuna;Liu Enshengb;Mu Ronga;Li Zhanguoa
    2010, 12(1): 21-5.
    Objective: To explore the incidence and risk factors of retinopathy induced by hydroxychloroquine. Methods:Search words such as hydroxychloroquine, antimalarials, eye, ocular, retinopathy, maculopathy, and retinotoxic were selected, and MEDLINE, EMBASE, OVID, Science Direct, and Springer databases were searched. The data of clinical use of hydroxychloroquine from the English literature published between 1963 and 2008 were collected. According to the criteria for entering, literature were strictly selected; incidence of retinopathy and nonretinopathy induced by hydroxychloroquine were calculated; relationship between the dosage of hydroxychloroquine, the length of drug use and retinopathy induced by hydroxychloroquine were analyzed. Results: Twenty one papers were selected. Of them, 11 were prospective study and 10 were retrospective study. A total of 5 210 patients entered the study. Of them, 25 patients had retinopathy and its incidence was 0.48%. In the prospective and retrospective studies, the incidences of retinopathy were (0.43% 11/2 549)and 0.53% (14/2 661), respectively. Ten of the 21 papers had evaluation of nonretinopathy and 2 599 patients entered the study. Of them, the incidences of corneal deposit and ocular muscle imbalance were 0.50% and 023%, respectively. Average daily dosage of hydroxychloroquine treatment was (7.6±3.4)mg/(kg·d)in the 25 patients developing retinopathy. The incidence of retinopathy was 0.40%(17/4 292)in patients receiving the dosage ≤6.5 mg/(kg·d) and 0.87%(8/918)in those receiving>6.5 mg/(kg·d). There was no significant difference between the two different dosages(P=0068). The average duration of hydroxychloroquine treatment was(63.5±56.5)months. The average time of drug use to retinopathy onset was (78.9±74.0)months in 17 patients receiving dosage ≤6.5 mg/(kg·d)and (46.8±20.2) months in 8 patents receiving dosage >6.5 mg/(kg·d). During 3 months of followup after drug discontinuation, of 25 patients, 9 patients’retinopathy was stable, 2 patients’visual field improved slightly, 1 patient’s retinopathy aggravated, and other 13 patients’outcome was not stated. Conclusion: Hydroxychloroquine might cause retinopathy, which is an irreversible lesion. Its incidence is lower and risk factors are dosage and the length of drug use. Therefore,correct dosage should be given and ocular examination should be performed regularly during the clinical use of hydroxychloroquine.
  • 调查研究
    Sun Zhenxiao;Zhang Li
    2010, 12(1): 26-5.
    Abstract ( ) PDF ( )
    Objective: To investigate the clinical features and causes of liver damage related to Polygonum multiflorum and its preparations in order to provide the preventive measures. Methods:The Chinese Journal Fulltext Database, Chinese Biomedical Literature Database, and Chinese Scientific and Technical Periodicals Database were searched, and the case reports of Polygonum multiflorum and its preparationrelated liver damage published in domestic literature from 1996 to 2009 were collected. The baseline characteristics of the patients, the situation of drug use, the clinical features, prognosis, and outcome of the liver damage were analysed. Results:A total of 35 patients had liver damage related to Polygonum multiflorum and its preparations. They comprised 20 men and 15 women with average age of (362 ±13.7) years. Of them, 14 received Chinese patent medicine alone, 18 received herbal pieces alone, and 3 received both Chinese patent medicine and herbal pieces. Among the patients receiving herbal pieces, 6 received raw herbal pieces, 2 received processed herbal pieces, and the others were not stated. Of the 35 patients, 18 experienced liver damage again after drug readministration, 3 might have a familial tendency to develop this disorder. The time to liver damage onset after drug administration was as follows: the shortest was 3~6 days, the longest was > 3 months, and the most was 1~4 weeks. The main clinical presentations were jaundice and abnormal liver function. The case reports of having records of liver function tests were as follows: the ALT levels in 31 patients were 102~4 584 U/L, the average level was 1 153.1 U/L; the AST levels in 25 patients were 61.5~1 937 U/L, the average level was 657.4 U/L; the average TBil levels in 29 patients were 134.9 μmol/L; the average DBil levels in 23 patients were 97.9 μmol/L. The patients with mild symptoms spontaneously recovered after drug discontinuation. Most patients were cured after receiving liverprotective treatment. Of the 35 patients, 2 improved and 33 were cured. Conclusion:Both raw and processed Polygonum multiflorum and its preparations may induce liver damage. The patients’previous history and family history of Polygonum multiflorum use should be reviewed before drug administration, the correct dose should be chosen, and the patients’liver function should be monitored during polygonum multiflorum use.
  • 安全用药

  • 安全用药
    Wang Guishuang;Cai Haodong
    2010, 12(1): 31-6.
    Adefovir dipivoxil and tenofovir are nucleotide analogue used for treatment of hepatitis B and other viral diseases. Recently, it has been reported that these two drugs have nephrotoxicity. Adefovir dipivoxil or tenofovirassociated nephrotoxicity is defined as an increase ≥0.5mg/dL from baseline in serum creatinine or a serum phosphorus value of <1.5 mg/dL on two consecutive laboratory tests. The incidence of adefovir dipivoxilassociated nephrotoxicity was doserelated; it is 22%~50% at dose ≥ 30 mg daily, and is similar to the placebo at dose 10 mg daily. The incidence of tenofovirassociated nephrotoxicity was markedly lower than that of adefovir dipivoxil. The severity of nephrotoxicity in most patients is relatively mild. The mechanism of nephrotoxicity may be associated with toxicity of these two drugs to mitochondria. The pathologic changes resulted from nephrotoxicity were mainly extensive edema of epithelium in proximal convoluted tubule, cellular necrosis and vacuolization. The preventive measures are as follows: the renal function and serum phosphorus levels should be monitored regularly during drug therapy; concomitant use of nephrotoxic drugs should be avoided; the drug dosage should be adjusted according to creatinine clearance rate.
  • 安全用药
    Jia Dongganga;Zhao Wanzhenb Lei Zhaobao
    2010, 12(1): 37-5.
    Amoxicillin-clavulanate potassium is a widely used antibiotic and its antimicrobial spectrum is the same as that of amoxicillin. Hepatitis and cholestatic jaundice related to amoxicillinclavulanate potassium have been reported. The mechanism is unclear, however, it may involve in immune reactions or metabolism factors. The incidence is about 0.001%~0.022%. The time to hepatotoxic reaction onset is several days or weeks( average 8.9 days) after treatment start. Clinical manifestations include jaundice, itching, weakness, nausea, vomiting, hepatomegaly, skin rash, abdominal pain, fever, and so on. The serum ALT, AST, alkaline phosphatase, and γ-GT levels markedly increase ( 2~10 times the upper limit of normal). Generally, jaundice subsided within 1 to 8 weeks after the drug discontinuation and liver functions return to within normal range 4 to 16 weeks after the drug stop. The risk factors for hepatotoxic reactions include male (the ratio of males to females is about 4 to 1 or 2 to 1 ), advanced age, long-term treatment, and combination therapy ( especially hepatotoxic drugs such as acetaminophen, allopurinol, and erythromycin ). Preventive measures are as follows: never use amoxicillin-clavulanate potassium unless there is a good indication; the drug should be avoided or used very carefully in male aged > 65 years; the treatment duration should not exceed 14 days; multidrug therapy should be avoided; monitoring should be performed during treatment. -
  • He Hanjun
    2010, 12(1): 41-2.
    Abstract ( ) PDF ( )
    A 52-year-old man with hypertension, hypertensive cardiopathy, and left ventricular hypertrophy received digoxin 0.125 mg once daily, benazepril 10 mg once daily, controlledrelease nifedipine 30 mg once daily, hydrochlorothiazide 25 mg once daily, and spironolactone 20 mg once daily. Seven days later, the patient developed bilateral, symmetrical breast enlargement accompanied by mild pressing pain and hyposexuality. Spironolactone was stopped. Five days later, his conditions relieved. The abovementioned symptoms recurred after readministration of spironolactone and improved markedly after the drug discontinuation again.
  • Chang Hongyua;Li Fanga;Nie Yalinga;Hou Qingxiangb;Zhang Hongc;Li Mand;Zeng Lia;Zhang Xiaa
    2010, 12(1): 42-3.
    Abstract ( ) PDF ( )
    A 53dayold female infant was hospitalized for somnolence and refusal to drink milk after she was given 2 drops of naphazoline nosal drops by parents themselves for nasal obstruction. On admission, physical examination showed a pulse of 80 beats/min, a respiratory rate of 30 breaths/min, depression, somnolence, pale face, low response, abnormal respiratory rhythm, peripheral coldness, weak primary reflection. Subsequently, she developed sobbing at long intervals, and her respiratory rate was 18~20 breaths/min. She was treated with oxygen inhalation, anisodamine, and naloxone. Six hours later, her symptoms improved and she recovered and was discharged after 3 days.
  • Li Lihua;Zhao Yilei;Jiao Yi
    2010, 12(1): 44-2.
    Abstract ( ) PDF ( )
    A 42yearold woman received tamoxifen 10 mg once daily for longterm maintenance therapy after undergoing mammary cancer radical operation. Irbesartan 150 mg once daily was added to her regimen due to hypertension. One month later, the patient developed painful left cervical and axillary lymph nodes and left breast. Mammary cancer metastasis was excluded. The abovementioned symptoms were considered to be irbesartanassociated. Irbesartan was stopped and tamoxifen was continued. One week later, his symptoms disappeared. Subsequently, amlodipine and metoprolol were used for control of blood pressure and the abovementioned symptoms did not recur.
  • Wang Hujun;Zhai Jianguo
    2010, 12(1): 53-2.
    Abstract ( ) PDF ( )
    Three male patients, aged 46~91 years, received respectively an IV infusion of linezolid 600 mg twice daily for infections. Their platelet counts were normal before linezolid administration. All of them developed thrombocytopenia after 3~17 days of therapy. Platelet counts were 95×109/L, 74×109/L, and 86×109/L, respectively. Linezolid was stopped and switched to imipenemcilastatin sodium, vancomycin, and meropenem; and other treatments were unchanged. The level of platelet returned to within normal range.
  • Zhang Xuguang
    2010, 12(1): 54-2.
    Abstract ( ) PDF ( )
    A 64yearold man received aspirin 300 mg once daily and clopidogrel 75 mg once daily and an IV infusion of urokinase 1.5 million units. Meanwhile he was treated with isosorbide dinitrate, metoprolol, and lovastatin. One month later, aspirin was reduced to 100 mg once daily while clopidogrel was maintained at constant dose. Seven months later, the patient developed fever and sore throat. Routine blood tests revealed the following levels: WBC count 1.6×109/L, PLT count 82×109/L. Clopidogrel was withdrawn and other treatments remained unchanged. Seven days later, the levels of WBC and platelet returned to normal range. Aspirin, metoprolol, and lovastatin were continued and there was no recurrence of thrombocytopenia at one year of follow up.
  • Wang Suobin;Jia Jianping
    2010, 12(1): 56-3.
    Abstract ( ) PDF ( )
    Two patients developed osmotic demyelination syndrome after receiving an IV infusion of pituitrin for hemoptysis secondary to pulmonary tuberculosis. Patient 1, a 45yearold man,received an IV infusion of pituitrin 10U on day 1, followed by 24~36U/d on days 2, 3, and 4. On day 5, pituitrin was discontinued. Pituitrin 24U/d was readministered for 2 days due to recurrence of hemoptysis. Subsequently, the patient developed agitation, paraphasia, and involuntary movement of his extremities. Laboratory testing revealed a blood sodium level of 110 mmol/L. After receiving a sodium supplement for 2 days, his blood sodium level increased to 134 mmol/L. A cranial MRT revealed symmetrical signal abnormities on long T1 and long T2 in his bilateral caudate nuclei and lenticular nuclei. Symptomatic treatments were given and the patients’symptoms improved somewhat.
  • Zhao Min;Zhang Xiuhong
    2010, 12(1): 58-2.
    Abstract ( ) PDF ( )
    Anaphylactic reactions appeared in two patients after administration of an IV infusion of rituximab. Patient 1, 61yearold women with nonHodgkin lymphoma, was hospitalized for chemotherapy. On day of admission, the patient received an IV infusion of rituximab 600 mg once daily. Two hours later, she developed throat discomfort followed by short of breath, chilliness, fever, shivers and her temperature was 37.8℃. Rituximab was withdrawn and an IV dexamethasone was given. Her symptoms relieved after two hours. About half an hour after restarting an IV infusion of rituximab, she experienced dysphyagia, short of breath, polyhydrosis with a BP of 80/52 mm Hg. Rituximab was stopped again and antiallergic therapy was given. Four hours later, her symptoms improved.Patient 2, 52yearold women with chronic lymphocytic leukemia, was treated with combined chemotherapy with fludarabine and rituximab. She received an IV infusion of rituximab 600 mg once daily. About half an hour later, the patient presented with chest distress, short of breath, tightened throat, lip cyanosis accompanied by chilliness, shivers, and diffuse wheezing in both lungs. Rituximab was discontinued and oxygen inhalation and antiallergic treatments were given. Two hours later, her symptoms relieved. On second day, she was administrated with combined chemotherapy with cyclophosphamide and fludarabine, the abovedescribed symptoms did not recur.
  • Yan Chunyan
    2010, 12(1): 60-1.
    Abstract ( ) PDF ( )
    A 67yearold man recevied an IV infusion of compound amino acid 250 ml once daily after undergoing resection of esophageal cancer. On day 3, the patient developed chest distress, short of breath, nausea, and polyhidrosis after infusion of compound amino acid about 15 ml. Compound amino acid was discontinued immediately, and then an IM of promethazine hydrochloride and an IV push of dexamethasone, adrenaline, lidocaine, and nikethamide were given. Meanwhile he underwent artificial respiration, external chest compression, and endotracheal intubation. Two hours later, the resuscitation was unsuccessful and he died.
  • Li Xuewena;Gu Xinb;Meng Fanchaoa;Zong Jieb;Cui Lanzhub;Lu Gangb;Huang Liangshengc
    2010, 12(1): 61-2.
    Abstract ( ) PDF ( )
    A 52yearold man underwent a CTA test. After an IV bolus injection of iohexol 20 ml, his heart rate increased from 65 beats/min to 90 beats/min and he developed throat discomfort, cough, and skin itching on hands. Then iohexol was withdrawn. Subsequently, the patient experienced generalized asthenia, faint, confusion, weak pulse, and polyhidrosis, her blood pressure was undetectable. Antiallergic, antishock, and symptomatic treatments were given immediately, his symptoms improved gradually. He recovered after one week.
  • Lu Qin
    2010, 12(1): 62-2.
    Abstract ( ) PDF ( )
    A 33yearold woman received an IV infusion of pazufloxacin 0.5 g in 0.9% sodium chloride 500 ml. After infusion of 60 ml, the patient developed headache, dizziness, coldness, involuntary head shaking, downward eye deviation, trismus, mild convulsion of extremities, signs of clawhand, and confusion. Pazufloxacin was withdrawn and promethazine and dexamethasone were given. Forty minutes later, her symptoms disappeared, but she could not remember what happened then. She was discharged after 24 hours of hospitalization and there was no recurrence at oneweek follow up.
  • Ding Ling;Hu Yi
    2010, 12(1): 63-1.
    Abstract ( ) PDF ( )
    A 73yearold man received an IV infusion of gatifloxacin 200 mg twice daily for acute attack of chronic obstructive pulmonary disease. Three days later, the patient developed agitation and fear. His symptoms worsened and experienced hallucination, delusion of persecution, and other mental symptoms in the following two days. Gatifloxacin was discontinued and diazepam and chlorpromazine hydrochloride were given. Two days later, abovementioned symptoms subsided.
  • 病例报告

  • 病例报告
    Qin Xuewei;Zhang Bin
    2010, 12(1): 64-1.
    Abstract ( ) PDF ( )
    A 64yearold woman undergoing an operation for lumbar spinal canal stenosis under general anesthesia received an IV infusion of atropine 0.5 mg and dexamethasone 10 mg via Muphy's dropper before surgery. Twenty mintues later, she developed palpitation, dyspnea, and squeezing pain in the substernal area. Meanwhile, her heart rate was 181 beats/min and blood pressure was 275/115 mm Hg. An IV push of esmolol, urapidil, and lidocaine hydrochloride was given successively, then her vital signs became stable and the operation was completed uneventfully.
  • 病例报告
    Li Hua;Zhao Hongyan;Zhao Junyan
    2010, 12(1): 65-1.
    Abstract ( ) PDF ( )
    A 38yearold woman was hospitalized for druginduced liver damage due to ketoconazole. After admission, the patient received an IV infusion of compound glycyrrhizin injection 100 ml ( containing glycyrrhizin 200 mg ) in 5% glucose 250 ml for two weeks. Subsequently, she developed generalized edema which was marked in her both lower extremities. Her blood pressure was within 136~140/90~100 mm Hg and the level of serum potassium was 2.56 mmol/L. The drug was discontinued, spironolactone tablets and controlled-release potassium chloride tablets were given. Seven days later, her symptoms improved. She was discharged after 26 days of hospitalization and had no discomfort at 2week follow up.
  • Sheng Xiaoyana;Tang Ziyonga;Duan Jinglia
    2010, 12(1): 66-2.
    Abstract ( ) PDF ( )
    A 17yearold women with pulmonary tuberculosis received pyrazinamide, ethambutol, rifampicin, and isoniazid. Two months later, pyrazinamide and ethambutol were stopped and rifampicin 0.45 g/d and isoniazid 0.3 g/d were continued. After another three months, the patient developed pitting edema in both lower extremities, followed by asthenia, short of breath, and frothy urine. Rifampicin and isoniazid were stopped. Laboratory tests revealed the following levels and values: plasma Alb 12.6 g/L, TG 2.11 mmol/L, 24hour urine protein 5.511~8.283 g, CCr 181 ml/min. Oral prednisolone and symptomatic treatment were given. Meanwhile, she was treated with pyrazinamide, ethambutol, and isoniazid for consolidation of therapeutic effect. Fifteen days later, her symptoms improved and she was discharged. She had no recurrence at follow up.
  • 病例报告

  • 病例报告
    Chen Guoqing;Zheng Guoyong
    2010, 12(1): 67-2.
    Abstract ( ) PDF ( )
    A 86yearold woman with hypertension, sequelae of cerebral infarction, and hyperlipemia received telmisartan, aspirin, nicergoline, simvastatin, Danhong injection, and deproteinized hemoderivative of calf blood injection. After 14 days of therapy, Danhong and deproteinized hemoderivative of calf blood injection were stopped and an IV infusion of meclofenoxate 0.25 g dissolved in 20 ml of sodium chloride 0.9% twice daily was added to his regimen. On the day of meclofenoxate administration, the patient experienced urinary frequency, urgency, and incontinence. Renal function revealed a BUN level of 7.10 mmol/L and a SCr level of 88 μmol/L. Meclofenoxate was withdrawn immediately and other medications were continued, his symptoms relieved gradually. Three days later, his condition was stable and he was discharged.
  • Xun Pinga;Sun Lib;Li Zhongyana;Yu Donghuia
    2010, 12(1): 68-2.
    Abstract ( ) PDF ( )
    A 50yearold man was hospitalized for angina pectoris. He received an IV infusion of sodium ferulate 0.3 g dissolved in 0.9% sodium chloride 150 ml and an IV infusion of cinepazide maleate 160 mg in 250 ml of glucose 5%. Meanwhile he was given aspirin, atorvastatin, benazepril, and isosorbide mononitrate. On admission, the patient developed diarrhea with 10 watery stools per day after infusion completion. On second day, his symptoms aggravated after readministration of an intravenous infusion. His diarrhea was considered possibly related to cinepazide maleate, and then cinepazide maleate was withdrawn and other medications were continued, his diarrhea stopped.
  • Guo Huijuan
    2010, 12(1): 69-1.
    Abstract ( ) PDF ( )
    A 26yearold women received Lulutongyimugao 10 ml orally after delivery. Five minutes later, the patient developed generalized skin itching, palpitation, dizziness, nausea, vomiting, and throat discomfort. About twenty minutes later, she presented with edema of lip, cyanosis, and dyspnea. Physical examination showed a BP of 90/55 mm Hg and a heart rate of 170 beats/min. Lulutongyimugao was withdrawn, and she was treated with an IV infusion of dexamethasone and vitamin C, oxygen inhalation, and underwent breath and ECG monitoring. Half an hour later, her symptoms relieved; one day later, her vital signs became stable. She was discharged after three days of hospitalization.