2009 Volume 11 Issue 6 Published: 28 December 2009

  

• Select all
  |

临床论著

• Select
  临床论著

  Clinical studies on antimicrobialassociated diarrhea in hospitalized elderly patients

  Li Dishan;Chen Haiping

  2009, 11(6): 381-5.

  Abstract ( )

  Objective: To study the related factors for antimicrobialassociated diarrhea (AAD) in hospitalized elderly patients. Methods: A prospective study was conducted from January 2007 to June 2008, 163 elderly patients were hospitalized with pulmonary, biliary, and urinary infections. The patients comprised 132 men and 31 women aged 65~103 years [average (82±7) years]. Antimicrobials were infused intravenously and the prescribed dosage was given according to the drug label. When using a certain antimicrobial to treat different patients, the drug was used with the same dosage, but the treatment course varied. The relationship between AAD and some factors, including the patients' age, duration of hospitalization, medical intervention( such as nasal feeding, intubation and mechanical ventilation, indwelling catheter) , the kinds of antimicrobial agents, and treatment course, was analysed. Results: Of the 163 patients, 48 developed antimicrobialassociated diarrhea. The incidence was 29.4%. Diarrhea occurred in 2~26 days after receiving the medicine. Nineteen patients had diarrhea with ＜5 stools per day. Twentynine patients had diarrhea with ≥5 stools per day. Loose stools and watery stools were commonly seen, and mucous stools and bloody purulent stools with abdominal pain and abdominal distention were seldom observed. The incidence of diarrhea in patients aged ＜80 years and those aged ≥80 years was 25.5% (13/51) and 31.3%(35/112), respectively. The difference was not statistically significant (P＞0.05). The incidence of AAD in patients with ＜30 days of hospitalization and those with ≥30 days of hospitalization was 17.8% (19/107) and 51.8%(29/56), respectively. The difference was statistically significant (P＜0.001). The incidence of AAD in the patients undergoing medical intervention and those undergoing no medical intervention was 78.9%(15/19) and 22.9%(33/144), respectively. The difference was statistically significant (P＜0.01). The incidence of AAD in patients receiving 1, 2, and ≥3 kinds of antimicrobials was 13.3%(11/83), 29.4%(15/51), and 75.9%（22/29）, respectively. The differences were statistically significant when the incidences were compared with each other （P＜0.05，P＜0.01）. The antimicrobial agents which induced high incidence of AAD were cefoperazonesulbactum (42.9%), clindamycin (40.0%),amoxicillinclavulanate potassium and piperacillintazobactam (35.7%). The incidence of AAD in the patients receiving ＜7 days, 7~15 days, and > 15 days of drug therapy were 14.3%(4/12), 20.8%(15/72), and 46.0%(29/63), respectively. Logistic multiregression analysis showed that combined use of antimicrobials and the medical intervention were independent risk factors for ADD. Conclusion: The elderly patients are prone to develop antimicrobialassociated diarrhea and its related factors include the kinds of antimicrobials, multiple drug therapy, prolonged drug use, and medical intervention. Close monitoring the AAD occurring should be performed in the elderly patients receiving antimicrobials.
• Select
  Autoimmune hepatitis induced by acitretin capsules and Qingdai capsules

  Han Junling;Wu Shuyun

  2009, 11(6): 385-2.

  Abstract ( ) PDF ( )

  A 39yearold man with psoriasis recurrence received acitretin capsules, Qingdai capsules, and compound aminopolypeptide tablets, as well as anthralin ointment for external application. Two months later, the patient developed pain in the hepatic region and abdominal distension. Liver function revealed the following values: ALT 71.0 U/L, AST 42.0 U/L, γGT 90.9 U/L. The abovementioned medicines were stopped and his symptoms were not relieved. Subsequently, repeated blood tests were positive for antinuclear antibody, antimitochondrial antibody, smooth muscle antibody, and liver and renal microsomal antibody. His liver function was abnormal. Liver biopsy was compatible with the pathological changes of druginduced hepatic damage. His liver function tests remained abnormal at follow up after one month.

临床论著

• Select
  临床论著

  范燕1;白楠2;王睿2*;宋秀杰2;梁蓓蓓2;李然2;李玉莲2;蔡芸2;柴栋2

  Fan Yan;Bai Nan;Wang Rui*;Song Xiu-jie;Liang Beibei;Li Ran;Li Yulian;Cai Yun;Chai Dong

  2009, 11(6): 386-5.

  Abstract ( )

  Objective: To evaluate the safety and tolerance of continuous intravenous infusions of caderofloxacin lactate injection in Chinese healthy adult volunteers. Methods:In AprilJuly 2009, 12 healthy adult volunteers were selected and enrolled in the study. They comprised 6 men and 6 women aged 25~35 years [average(31.8±2.8) years]. Their body mass index was 19.8~24.1（22.2±1.3）kg/m2. Caderofloxacin lactate 400 mg/2 h was infused intravenously at a constant rate once daily for 7 days. The subjects’vital signs and adverse events were observed and recorded. The routine blood and urine tests as well as biochemical tests were performed. The intensive monitoring for the changes in the QT interval and corrected QT（QTc） interval one hour before drug initiation and 3 and 6 hours after drug initiation as well as OGTT on days 3, 5, and 8 after drug initiation were performed. Results: Eleven subjects completed a 7day continuous infusions but one woman stopped her infusion due to menstruation on day 3. The subjects’ body temperature, pulse, respiratory rate and blood pressure and other vital signs were within the normal range after drug administration. A total of 7 cases of adverse events occurring included 5 cases of slightly increased triglyceride levels, one case of slightly increased total protein levels, one case of transient low blood glucose level(2.96 mmol/L). The 7 adverse events may not have a causal relationship with the drug in the analysis. On days 2, 5, and 8 after drug initiation, one subjects’WBC count (2.75×10⁹/L, 3.07×10⁹/L, and 2.95×10⁹/L, respectively) and neutrophil count (0.39, 0.33, and 0.39, respectively) were lower than the normal limits, but both normalized 2 days after drug discontinuation. The events may be associated with the drug. On 7 successive days after drug initiation, the difference in a certain level of AST, TB, and urea among the days was statistically significant (all P＜0.05), but there was no clinical significance. On days 2, 3, 4, and 7 after drug initiation, the QT interval prolonged compared with before drug administration, but the QT interval was ＜450 ms. No abnormal changes in clinical significance were seen. On day 5 after drug initiation, 11 subjects’ fasting blood glucose level was (4.21±0.35)mmol/L, which was lower than that [(4.74±0.59)mmol/L] 1 day before drug administration. On days 3 and 5, 11 subjects’ blood glucose levels one hour after meal was (6.20±1.58), (6.07±1.19) mmol/L, which were lower than that [(8.47±2.51) mmol/L)] one day before drug administration. Although the difference was statistically significant (P＜0.05), but there was no clinical significance. Other routine blood and urine tests as well as biochemical tests revealed no marked changes before and after drug administration. Conclusion: Continuous intravenous infusions of caderofloxacin lactate injection exhibit good tolerance and safety

实验论著

• Select
  实验论著

  Protective effects of glutamine on nonsteroidal antiinflammatory durginduced smallintestinal mucosal lesions in rats

  Luo Jia;Wang Huiji*

  2009, 11(6): 391-6.

  Abstract ( )

  ＡＢＳＴＲＡＣＴObjective: To study the protective effects of glutamine on nonsteroidal antiinflammatory durg (NSAID)induced smallintestinal mucosal lesions in rats in order to provide the basis for safe drug use. Methods:Ninety SPF grade male SpragueDawley rats were randomly allocated into nine groups: the 4 model groups, the 4 protection groups, and the 1 empty control group. Each group comprised ten rats. The rats in the 4 model groups were given indomethacim 2.5 mg/kg, aspirin 50 mg/kg, ibuprofen 30 mg/kg, and celebrex 20 mg/kg twice daily for 14 days, respectively. The rats in the 4 protection groups were given abovementioned four different kinds of NSAIDs, meanwhile glutamine 100 mg/kg was given at the same time, respectively. All drugs were dissolved in 2 ml of sodium carbaxymethycellulose ( CMC ), which was passed into the stomach. The rats in the empty control group were given 2 ml of CMC. On day 15, all rats were sacrificed. The depth and area of rats’smallintestinal mucosal lesion were measured with the CMIAS multifunction color image analytical system, and the accumulative depth and area of the lesions were calculated. The myeloperoxidase (MPO), malondialdehyde( MDA ), superoxide dismutase (SOD), nitric oxide (NO) levels in the smallintestinal homogenate were measured. Results: In the indomethacin, aspirin, ibuprofen, and celebex model groups, the accumulative depth of smallintestinal mucosal lesions was 5 954, 511, 1 361, and 1 447 μm, respectively, the accumulative area of smallintestinal mucosal lesions was 1 956 592, 164 304, 339 711, and 445 611 μm2, respectively. The differences were statistically significant in all the model groups compared with the empty control group except the aspirin group (all P＜0.05 ). The severity of lesions in the indomethacin group was greater than that in the other model groups( P＜0.05 ). In the indomethacin, aspirin, ibuprofen, and celebrex protection groups, the acumulative depth and area of smallintestinal mucosal lesion were 1206, 443, 616, and 723 μm as well as 390 450, 92 192, 209 655, and 238 827 μm2，respectively. Their severity of lesions was markedly lower than that of the model groups. In the indomethacin, aspirin, ibuprofen, and celebrex protection groups, the MPO levels were （1.10±0.35）,（0.53±0.19）,（0.83±024）,and（0.37±0.17）U/g; and in the corresponding model groups, the MPO levels were （2.37±0.63）,（1.66±0.50）,（1.35±035）, and（1.14±0.38）U/g. The MPO levels in the protection groups were markedly lower than those in the corresponding model groups. The differences were statistically significant (all P＜0.05 ). The MDA levels in the indomethacin protection group were markedly lower than those in the indomethacin model group[（0.50±0.16）vs（1.19±0.77）nmol/mg, P＜0.05）]. The SOD levels in the indomethacine, aspirin, ibuprofen, and celebrex model groups were respectively （3.53±0.64）,（4.03±1.28）,（3.44±1.05）, and（3.70±1.53）U/mg, which were markedly lower than those in the empty control group[（5.49±1.09）U/mg, all P＜0.05）]. The SOD levels in the corresponding protection groups were respectively（4.03±1.28）,（4.46±1.10）,（4.29±1.53）, and（4.00±1.08）U/mg, which were higher than those in the model groups, but there were no statistically significant differences. There were no statistically significant differences in the NO levels between the protection groups and model groups (P＞0.05). Conclusion: Glutamine has protective effects on NSAIDinduced smallintestinal mucosal lesions in rats.

病例报告

• Select
  病例报告

  Mental disorder associated with levofloxacin

  Li Qizhi;Yang Xiaowei;Yan Zhijun;Zhang Dongsheng;Jiang Zaihui

  2009, 11(6): 396-1.

  Abstract ( ) PDF ( )

  A 90yearold man received an IV infusion of levofloxacin 0.3 g twice daily and then an IV infusion of adenosine triphosphate 20 mg, coenzyme A 100 U, and 7 ml of sodium chloride 10% dissolved in 250 ml of glucose 5% once daily for pneumonia complicated by cephalic shingles. The second day, the patient developed sleeplessness, auditory hallucination, visual hallucination, and thought incoherence. Neurological examination did not show positive signs. Levofloxacin was stopped and switched to azithromycin. One day later, his mental symptoms disappeared.

调查研究

• Select
  调查研究

  Meta-analysis of the risk of developing serious infections following treatment with tumor necrosis factorα inhibitors for rheumatoid arthritis

  Sun Lin;Liu Xiangyuan;Zhao Jinxia;Deng Xiaoli

  2009, 11(6): 397-9.

  Abstract ( )

  Objective: To assess the risk of serious infections associated with tumor necrosis factorα(TNFα) inhibitors (etanercept, infliximab, and adalimumab) for treating patients with rheumatoid arthritis (RA). Methods:Searching PubMed, EMBASE, and Cochrane Library from January 1998 to January 2009, the published literature of randomized controlled trials on serious infections related to TNFα inhibitor use for treating patients with rheumatoid arthritis was collected. According to the criteria for entering, the literature was strictly selected and the quality of selected literature was assessed based on the demand of metaanalysis. And its results were analyzed by Review Manager 4.2 software. The odds ratio (OR), 95% confidence interval (95%CI), and P value for serious infections were calculated to assess the effect of TNFα on the risks of developing serious infections in patients with RA. Results: Sixteen randomized controlled trials were selected for metaanalysis. The 16 trials included 4 articles on etanercept, 5 on infliximab, and 7 on adalimumab. A total of 8541 patients entered the trials. Of them, 5 812 patients were in the TNFα group (1 347 patients receiving etanercept, 2 064 patients receiving infliximab, and 2 401 parents receiving adalimumab), and 2 729 patients in the control group. Metaanalysis revealed the following results: the pooled OR (95% CI) to serious infections was 1.43 (95% CI 1.08～1.89, P<0.05) in the TNFα inhibitor group, compared with the control group. In the etanercept, infliximab, and adalimumab groups, the OR (95% CI) was 0.93 (95% CI 0.59～1.45, P>0.05), 1.68 (95% CI 1.05～2.68, P<0.05), and 2.07 (95% CI 1.15～3.37, P<0.05), respectively. The risk of developing serious infections in the highdose TNFα inhibitor group was higher than that in the lowdose TNFα inhibitor group (OR 1.62, 95% CI 1.13～2.33, P<0.01) and the control group (OR 1.87, 95% CI 1.30～2.69, P<0.01). The differences were statistically significant. In a comparison of the lowdose TNFα inhibitor group to the control group (OR 1.31, 95% CI 0.93～1.85, P>0.05), there was no statistically significant deference in the risk of developing serious infections. Conclusion:The patients with rheumatoid arthritis receiving TNFα inhibitors could increase a degree of the risk of developing serious infections, especially in higher dosage. Therefore, the patients should be closely monitored following treatment with TNFα inhibitors in clinical practice.
• Select
  调查研究

  Neurotoxicity induced by cefepime use in patients with chronic renal failure

  Zhang Yan;Zhu Haiying;Cheng Hongqin;Chu Yanqi;Yang Yiwei;Fu Qiang

  2009, 11(6): 406-4.

  Abstract ( )

  Objective: To investigate the clinical features of neurotoxicity induced by cefepime use in patients with chronic renal failure in order to provide the basis for rational use of cefepime. Methods:In JanuaryApril 2009, 6 patients with chronic renal failure receiving cefepime were enrolled in the investigation. The time to neurological symptom onset, clinical presentations, and the time to the symptom relief were investigated. The liver and renal function, blood glucose, electrolyte, pH, pO₂, and pCO₂ levels were measured. Results: Six patients comprised 3 men and 3 women aged 54～92 years [avaergy age (74±13)]. All 6 patients received an IV infusion of cefepime 2～8 g daily for pulmonary infections.Neurological symptoms occurred in 1～3 days after initiation of cefepime infusion.　Clinical presentations included agitation, verbal incoherence, delirium, confusion, somnolence, and 1 case of involuntary tremor of the extremities. The symptoms relieved within 3 days after cefepime discontinuation and symptomatic therapy. There was no marked difference in biochemical values in all 6 patients before and after cefipime administration. Conclusion: Neurotoxicity may occur in patients with chronic renal failure receiving an IV infusion of cefepime; care should be taken when using cefepime to treat patients with renal failure.

安全用药

• Select
  安全用药

  Risk factors for venous thromboembolism occurring during treatment of multiple myeloma with thalidomide or lenalidomide and its prevention

  Yu　Yaping

  2009, 11(6): 410-6.

  Abstract ( ) PDF ( )

  An increased risk of venous thromboembolism (VTE) may occur in patients with multiple myeloma( the incidence is about 3%~10%), the risk could further increase during treatment with thalidomide or lenalidomide. The risk factors for VTE are age, obesity, history of venous thromboembolism, central venous catheter, complications (infections, diabetes mellitus, cardiovascular disease, etc.), surgery, hereditary thrombophilia, combined therapy with highdose dexamethasone, doxorubicin, erythropoietin, or multidrug chemotherapy. Generally, the time to VTE onset is within 6 months after treatment. A study shows that incidence of VTE may decrease after receiving prophylaxis of venous thrombosis during treatment with thalidomide or lenalidomide. VTE may be prevented as follows: lowrisk patients receive aspirin; highrisk patients receive low molecular weight heparin(LMWH) or an adequate dosage of warfarin; the patients receiving highdose dexamethasone or doxorubicin or multidrug chemotherapy should be administered LMWH or an adequate dosage of warfarin for 4~6 months in general.
• Select
  安全用药

  Licorice and glycyrrhizinic acid preparationinduced pseudohyperaldosteronism: prevention and treatment

  Liu Ran

  2009, 11(6): 416-4.

  Abstract ( )

  Licorice is a commonly used traditional Chinese medicine which mainly contains glycyrrhizin ( glycyrrhizinic acid ), glycyrrhetinic acid, and flavonoid. Large dosage or longterm use of licorice or glycyrrhizinic acid may cause pesudohyperaldosteronism. Clinical presentations are increased blood pressure, palpitation, shortness of breath, arrhythmia, somnolence, generalised asthenia, tetraplegia, hypokalemia, lower limb and systemic edema, etc. The subjects prone to developing pseudohyperaldoteronism include the elderly, women, and those with cardiovascular disease or renal impairment. The mechanism of pseudohyperaldoteronism from licorice or glycyrrhizinic acid is associated with inhibition of 11 betahydroxysteroiddehydrogenase and increased activation of mineralocorticoid receptors. The measures of prevention and treatment are as follows: large dosage and longterm use of licorice or glycyrrhizinic acid should be avoid; the drug should be used very carefully in the elderly, the patients with cardiovascular disease, renal disease, hypertension, and diabetes mellitus; licorice or glycyrrhizinic acid in combination with cardiac glycoside or diuretics should be avoided; serum potassium level should be measured and blood pressure should be monitored regularly during drug therapy; once pseudohyperaldosteronism occurs, the drug should be stopped; patients with severe symptoms should be administered an appropriate potassium supplement, oral triamterence, and a low sodium diet.

• Select
  Parotid swelling related to azithromycin

  Sun Shuzhena;Yang Dongpingb

  2009, 11(6): 419-2.

  Abstract ( ) PDF ( )

  A 36yearold woman, who underwent cesarean section, received an IV infusion of azithromycin 0.5 g+vitamin B6 200 mg in 5% glucose 500 ml for prevention of infections. Eight hours later, the patient experienced bilateral parotid swelling, mild pressing pain, and difficulty in opening mouth. Azithromycin was stopped and his symptoms subsided.

安全用药

• Select
  安全用药

  Ceftriaxone-induced immune hemolytic anemia: clinical features, prevention, and treatment

  Yan Xuelian;Zhang Cuilian;Li Dakui

  2009, 11(6): 420-5.

  Abstract ( ) PDF ( )

  Ceftriaxone is a thirdgeneration cephalosporin antibiotic which is used widely in clinical practice. The common adverse reactions to ceftriaxone are allergic reactions and gastrointestinal disorders. Ceftriaxone also causes hemolytic anemia which is being reported with increasing frequency recently. The authors have searched the foreign and domestic literature, and there have been 21 cases of immune hemolytic anemia caused by ceftriaxone. Of them, there have been 16 cases reported in the foreign literature including 8 deaths, and 5 cases reported in the domestic literature including one death. Generally, the dosage of ceftriaxone is 1~4 g. The time to hemolytic reaction onset is several minutes to days after ceftriaxone administration. Clinical presentations include dizziness, palpitation, short of breath, lumbago with hematuria, proteinuria; hemoglobin values were lower than the normal level, direct Coombs test was positive. The mechanism is attributed to immunecomplex reactions. Ceftriaxoneinduced immune hemolytic anemia is rare, but its mortality is high. If hemolytic reactions occur, ceftriaxone should be stopped, IV dexamethasone and a washed RBC infusion should be administered, and the urine should be alkalised.

滥用误用

• Select
  滥用误用

  Hepatic venular occlusive disease related to Tusanqi

  Zhang Junxia

  2009, 11(6): 425-427.

  Abstract ( ) PDF ( )

  A 44yearold man received Tusanqi(Senecio chrysanthemoides DC) 30g/d as a substitute for tea for eight weeks for leg pain and total doses were 1680g. After administration of Tusanqi the patient developed abdominal distension, asthenia, anorexia, dark urine, yellowish skin and sclera, and ascites. Liver function testing revealed the following levels and values: ALT 388.9U/L, AST 394.3 U/L, TBil 86.8 μmol/L, PTA 37.8%. Examinations showed intraabdominal infections. Gastroscopy revealed varicosity of oesophagus and gastric fundus. His abdominal CT scan showed evidence of hepatic venular occlusive disease. Antiinfective and symptomatic treatments were given. His liver function did not improve, intraabdominal infections was not controlled, and ascites did not subside. The patient was discharged voluntary.
• Select
  Mental disorders due to omeprazole

  Jia Qinhui;Ning Hongxia;Li Fang

  2009, 11(6): 427-1.

  Abstract ( ) PDF ( )

  A 86yearold man with aplastic anemia received omeprazole 80 mg/d via an IV pump for control of upper gastrointestinal hemorrhage. On day 8 of therapy, the patient developed agitation, hyperphasia, irritability, loss of selfcontrol, refusal to eat, pulling out a stomach tube on his own, hallucination and illusion, and refusal of all therapy. On day 10 of therapy, omeprazole was stopped. Three days later, his mental symptoms relieved gradually. The abovementioned symptoms recurred after readministration of omeprazole via an IV pump and subsided after the drug discontinuation.
• Select
  Ceftriaxoneinduced anaphylactic shock mistaken for postural hypotension from anesthesia during surgery

  Tian Zhaolong;Li Yanhong;Wang Tianlong

  2009, 11(6): 428-2.

  Abstract ( ) PDF ( )

  A 43yearold man underwent an operation for pain in both lower limbs after spinal cord impairment. His blood pressure was 157/100 mm Hg after admission and 110/70 mm Hg after anesthesia induction during surgery. Subsequently, the patient was given an IV infusion of ceftriaxone 2 g dissolved in 100 ml of sodium chlorid 0.9% after he was turned over from dorsal position to prone position. Several minutes later, his blood pressure dropped to 60/40 mmHg and his heart rate was 100 beats/min. Electrocardiogram revealed an inverted T wave. Postural hypotension was considered and his condition improved after management. The surgery was completely uneventfully. His vital signs were stable after operation. On day 2, the patient received an IV infusion of ceftriaxone again. After infusion of 10 ml, he experienced generalized itching, chest distress, polyhidrosis, and dyspnea suddenly. Physical examination showed a BP of 70/40 mm Hg, a heart rate of 130 beats/min, and a SpO2 of 0.80. Ceftriaxone was withdrawn immediately and antiallergic treatment, fluid expansion, and antishock therapy were given. Finally, his symptoms disappeared and blood pressure returned to within normal range.
• Select
  Death from pulmonary interstitial fibrosis and liver damage after taking gefitinib

  Peng Wei;Gao Jie;Miao Liyan

  2009, 11(6): 429-2.

  Abstract ( ) PDF ( )

  A 65yearold man with lung cancer received gefitinib 250 mg once daily due to poor tolerance to several chemotherapeutic drugs. Two days later, the patient presented with chest distress, short of breath, and wheezing was heard in both lungs. His oxygen saturation was 0.60. Laboratory tests revealed the following levels and values: PO₂ 63 mm Hg, PCO₂ 45 mm Hg, ALT 445 U/L, AST 383 U/L, LDH 2 277 U/L, HBDH 968 U/L. A pulmonary CT scan showed bilateral pulmonary interstitial fibrosis with infections. Gefitinib was withdrawn. He was treated with an IV push of methylprednisolone, ambroxol hydrochloride, and omeprazole. His symptoms did not resolve. The resuscitation was unsuccessful and he died from multiple organ failure.
• Select
  Death from anaphylactic shock following administration of cefminox sodium in a patient with a negative cefminox sodium skin test

  Zhang Qingwen;Dong Yonghua

  2009, 11(6): 431-1.

  Abstract ( ) PDF ( )

  A 68yearold man with prostatic hyperplasia received an IV infusion of cefminox sodium 3.0 g in 0.9% sodium chloride 250 ml twice daily and an IV infusion of amoxicillin and clavulanate potassium 1.8 g in 0.9% sodium chloride 250 ml twice daily for prevention of infections for 5 days. On day 6, after infusion of 10 ml of cefminox sodium, the patient developed dizziness, nausea, chest distress, polyhidrosis, weak pulse, undetectable blood pressure. The infusion was stopped immediately. Oxygen inhalation, SC adrenaline, an IV push of dexamethasone, and an IV infusion of dopamine were given. Subsequently, his symptoms worsened and he presented with unconsciousness, deep coma without spontaneously breathing. Finally, the patient died despite resuscitation attempts.

病例报告

• Select
  病例报告

  Liver damage associated with ebastine

  Chen Fuchao;Li Peng;Fang Baoxia

  2009, 11(6): 432-1.

  Abstract ( ) PDF ( )

  A 69yearold man with allergic dermatitis was given ebastine 10 mg once daily 0.05%, beclometasone cream and 03% ciprofloxacin lactate cream for external application. Fifteen days later, the patient developed aggravated rash and his liver function tests revealed the following values: ALT 173 U/L, AST 120 U/L. Ebastine and ciprofloxcin lactate cream were stopped. Antiallergic and liverprotective treatments were administrated. One week later, his rash improved and liver function returned to within normal range.
• Select
  Cholestatic jaundice associated with atorvastatin calcium

  Sun Yunchuana;Jiang Jialib

  2009, 11(6): 433-2.

  Abstract ( ) PDF ( )

  A 74yearold man with coronary heart disease received atorvastatin calcium 20 mg once daily, isosorbide mononitrate 20 mg twice daily, metoprolol 25 mg twice daily, fosinopril sodium 10 mg once daily, and entericcoated aspirin 0.1 g once daily. After about 3 months of therapy, the patient developed yellowish skin and sclera, skin itching, claylike stool, and dark urine. Laboratory tests revealed the following levels and values: ALT 85 U/L, AST 80 U/L, TBil 246.8 μmol/L, DBil 138 μmol/L, total bile acid 95.5 μmol/L, ALP 221 U/L, γGT 240 U/L, urine bilirubin 50 μmol/L. Atorvastatin calcium was discontinued and other medications were continued. Meanwhile liverprotective treatment was given and his symptoms improved. Fiftyone days later, his liver function normalized.
  
• Select
  Thrombocytopenia and upper gastrointestinal haemorrhage induced by sustainedrelease sodium valproate tablets

  Wang Hongyana;Lin Zhusenb;Zhu Xiaofaa;Rui Menga;Hua Cana

  2009, 11(6): 434-2.

  Abstract ( ) PDF ( )

  A 91yearold man with bullous pemphigoid took longterm oral prednisone acetate tablets 5 mg/d. He received sustainedrelease sodium valproate 250 mg once daily for epileptic seizure. Five months later, the dosage was increased to 500 mg once daily. After 2 weeks, the patient experienced 3 tarry stools. Laboratory tests revealed the following levels: Hb 84 g/L, PLT 45×10⁹/L; stool occult blood (+). Sustainedrelease sodium valproate tablets was decreased to 125 mg once daily and symptomatic therapy was given. Seven days later, his platelet count normalized and upper gastrointestinal haemorrhage subsided.
• Select
  Hemorrhagic colitis associated with amoxicillin

  Zhou Hong

  2009, 11(6): 435-2.

  Abstract ( ) PDF ( )

  A 70yearold woman received tinidazole 2 g twice daily for two days. On day 3, amoxicillin 0.5 g thrice daily was added to the regimen. On the next day, the patient developed diarrhea with 3～6 bloody stools per day. Routine stool test showed RBC 200 cells/HP, WBC 10 cells/HP, occult blood (+); and enteroscope revealed pathological changes consistent with haemorrhagic colitis. Amoxicillin was stopped.Meanwhile fluid supplementation and symptomatic treatment were given, his condition became stable. Two weeks later, his symptoms improved obviously.

病例报告

• Select
  病例报告

  Gingival hyperplasia after administration of nifedipine: 2 case reports

  Zhai Yinghui;Li Haitao

  2009, 11(6): 436-3.

  Abstract ( ) PDF ( )

  Two patients with hypertension developed gingival hyperplasia after administration of nifedipine. Patient 1, a 43yearold man, recevied nifedipine 10 mg twice daily. After 5 years of therapy, the patient developed of gingival papilla enlargement accompanied by hyperemia of gingival margin. Nifedipine was withdrawn and changed to candesartan cilexetil. One months later, his symptoms improved.Patient 2, a 78yearold woman, was treated with nifedipine 30 mg once daily due to poor control of hypertension. After one year of the therapy, the patient experienced of gingival papilla enlargement with mild hyperemia. Nifedipine was discontinued and switched to amlodipine. Two weeks later, her symptoms relieved.
• Select
  Acute leukemia associated with azathioprine: a case report and review of literature

  Cao Shufang; Huang Dongwei;Tan Ruixing;Zhang Deming

  2009, 11(6): 439-3.

  Abstract ( ) PDF ( )

  A 78yearold man with idiopathic pulmonary interstitial fibrosis received combination therapy with prednisone, azathioprine, and tripterygium glycosides. Azathioprine 150 mg/d was given for 19 months and the total dose was 93 g. Two year later, the patient developed fever and dyspnea. On admission, routine blood test revealed following values: WBC count 0.83×10⁹/L, N 006, L 0.86, M 0.18~0.39, PLT count 74×10⁹/L, Hb 121 g/L. Bone marrow smear showed marked hyperplasia of nucleated cells with 50% unclassifiable cells which was dark grey and mediumlarge with pseudopods and small redpruple particales filling with the cytoplasm without Auer body. Bone marrow biopsy showed hypoplasia and decreases in three cell lineages. Staining of blood cells was negative or weakly positive for peroxidase and 90% positive rate of alkaline phosphatase. On day 76 of admission, bone marrow picture revealed marked hyperplasia of nucleated cells with 56% immature mononuclear and inhibition of three cell lineages on reexamination. A SC cytarabine 200 mg/d was given for 2 days, but this had no obvious effect. On day 128 of admission, he died.
• Select
  Leukopenia and thrombocytopenia associated with carbamazepine

  Yang Xinyun;Xiao Liting

  2009, 11(6): 441-2.

  Abstract ( ) PDF ( )

  A 58yearold woman was hospitalized with greater occipital neuralgia. After admission, routine blood examination revealed a WBC count of 4.90×10⁹/L and a platelet count of 273×10⁹/L. Carbamazepine 0.1 g twice daily was given. The next day, the dosage was changed to carbamazeping 0.1 g thrice daily, then clonazepam, rotundine, and lansoprazole were given. Two days later, her headache was exacerbated. The carbamazepine dosage was increased to 0.2 g thrice daily, then paracetamol and dihydrocodeine tablets were added to the regimen. Eight days later, the patient developed diffuse ecchymosis involving her trunk. Routine blood testing showed following values : WBC count 2.87×10⁹/L and PLT count 4×10⁹/L. Carbamazepine was stopped, and other medications were continued. Etamsylate, methylprednisolone, and platelet transfusions were given. After five days of the therapy, his values of blood routine testing normalized.
• Select
  Secondary thrombocytosis due to imipenem-cilastatin sodium

  Xiao Lan;Yang Mingli

  2009, 11(6): 443-2.

  Abstract ( ) PDF ( )

  A two years and ten months girl was hospitalized for cough and fever. Routine blood tests revealed the following levels: WBC count 10×10⁹/L, Hb 105g/L，PLT count 188×10⁹/L. The patient was given with cefuroxime sodium for 5 days but the therapy had poor effect. Lobar pneumonia was considered. On day 6 of admission, his routine blood test showed a WBC count of 14×10⁹/L, a Hb level of 97g/L, and a PLT count of 254×10⁹/L. He received imipenemcilastatin sodium 70 mg every eight hours. On day 11 of admission, routine blood test revealed the following: WBC count 15.7×10⁹/L, Hb 104 g/L, PLT count 1 349×10⁹/L. Bone marrow aspiration showed marked hyperplasia and all kinds of megakaryocytes and platelets covering smear. On day 13, imipenemcilastatin was discontinued. On day 14, routine blood test revealed a WBC count of 6.9×10⁹/L, a Hb level of 104 g/L, and a PLT count of 226×10⁹/L.

病例报告

• Select
  病例报告

  Two cases of cinepazide maleatecaused pain in both lower extremities

  Cai Yana;Yang Pinglinb;Zang Quanjinb;Bao Hea

  2009, 11(6): 444-2.

  Abstract ( ) PDF ( )

  Two female patients, respectively aged 54 and 50 years, received an IV infusion of cinepazide maleate 320 mg dissolved in 5% glucose 500 ml after undergoing lumbar operation. During infusion, the patients developed pain in both lower extremities and their symptoms relieved gradually after stopping cinepazide maleate. On day 2, the abovementioned symptoms recurred after readministration of cinepazide maleate in patient 1 and improved after the drug discontinuation
• Select
  Severe skin itching with rash attributed to gefitinib

  Zhang Haiying;Li Yuzhen

  2009, 11(6): 445-2.

  Abstract ( ) PDF ( )

  A 52yearold woman received gefitinib 250 mg once daily for adenocarcinoma of right lung. After 3 months of the therapy, the patient developed generalised itching with rash. Subsequently, the lesion was aggravated and she experienced perioral vesicles and dysphagia. Gefitinib was withdrawn and vitamin C and calcium gluconate were given, and then his skin sympotms improved.

中药不良反应

• Select
  中药不良反应

  Anaphylactic shock after Danhong injection

  Bao Zhongyinga;Qiu Shuangb;Yuan Xiaodong

  2009, 11(6): 447-1.

  Abstract ( ) PDF ( )

  A 75yearold man with vertebrobasilar ischemia received an IV infusion of Danhong injection 20 ml in 5% glucose 250 ml. About 1-2 minutes after infusion initiation, the patient developed feverish face with itching, swelling of both eyelids and lips, tightening sensation in the pharyneal region, dyspnea, palpitation, and cold sweat. An examination revealed a heart rate of 136 beats/min and a BP of 50/30 mm Hg. Danhong injection was stopped immediately, and oxygen inhalation, adrenaline, dopamine, and dexamethasone were given. Twelve hours later, his vital signs became stable, and he was discharged without discomfort.
• Select
  中药不良反应

  Liver damage caused by Bushenyinao capsules

  Zhang Ming;Qian Lu;Wang Yuliang;Shi Geping;Chen Qian

  2009, 11(6): 448-2.

  Abstract ( ) PDF ( )

  A 53yearold woman with neurasthenia and neurosis received 4 Bushenyinao capsules thrice daily and estazolam 2 mg at bedtime. After 70 days, her mental symptoms recurred, accompanied by somnolence, yellowish skin and sclera. Liver function revealed the following values: ALT 274 U/L, AST 57.0 U/L, TBiL 32.4 μmol/L, DBiL 19.8 μmol/L and routine urine tests showed bilirubin (++), urobilinogen (++), and ketone (+). Bushenyinao capsules were stopped, estazolam was continued, and liverprotective treatments were given. Three weeks later, her liver function returned to within normal range.