2009 Volume 11 Issue 1 Published: 28 February 2009
  

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    论著

  • 论著
    Du Yuanyun;Zhu Wei;Lian Shi;Feng Jingchun;Zhao Guang;Liu Quanzhong
    2009, 11(1): 1-4.
    Abstract ( ) PDF ( )
    Objective: To observe and evaluate the clinical efficacy and safety of capsaicin liniment in treatment of patients with postherpetic neuralgia. Methods: A multicenter, randomized, doubleblind, placebocontrolled study was performed. Between September 2005 and December 2007, Two hundred and forty patients with postherpetic neuralgia who met the selection criteria were enrolled in this study. Of the 240 patients, 231 met the intentiontotreat analysis and entered the efficacy evaluation. The 231 patients were randomly divided into two groups: the treatment group (117 cases) and the control group (114 cases). The treatment group comprised 52 men and 65 women [average age (59.23±10.12) years, mean disease duration 5(1, 398) months]. The control group comprised 53 men and 58 women [3 patients' sex not stated, average age (57.44±11.32) years, mean disease duration 5(1,110) months]. The patients in the treatment group applied 0.075% capsaicin liniment and the patients in the control group applied its inactive vehicle liniment. The 0.075% capsaicin liniment and its inactive vehicle liniment were applied to the area of postherpetic neuralgia three times a day, respectively. The treatment duration was 2 weeks. A return visit examination was performed once a week. The efficacy, adverse reactions and changes in routine blood, routine urine, liver and renal function tests were observed. Results: Twentyeight patients were lost to followup (no evaluating data in 3 cases in the treatment group and 6 cases in the control group). The total effective rate to postherpetic neuralgia in the treatment and control groups were 86.32% (101/107) and 31.58% (36/114), respectively. The difference between the two groups was statistically significant (P<0.05). The main adverse reactions were a burning skin sensation, local redness and swelling. The incidence of adverse reactions in the treatment and control groups were 9.17% (11/120) and 8.33% (10/120), respectively. There was no statistically difference between the two groups (P>0.05). Conclusion: Capsaicin liniment is an effective and relatively safe agent in treatment of postherpetic neuralgia.
  • 论著
    Zhang Yunjian;Liu Chunping;Zhang Weihua;Xia Guoguang
    2009, 11(1): 5-4.
    Abstract ( ) PDF ( )
    Objective: To analyse the clinical characteristics and management of syndrome of inappropriate secretion of antidiuretic hormone(SIADH) induced by pituitrin in order to benefit the safe use of pituitrin. Methods:Clinical data from patients with hemoptysis receiving pituitrin from 3 hospitals were collected between January 2000 and December 2007. The serum and urine sodium, plasma and urine osmolality, liver and renal functions, treatment, and outcome were analysed in patients who met the criteria for SIADH. Results: A total of 304 patients with hemoptysis received pituitrin therapy. Of them, 89 patients (53 men and 36 women) with age 21~82 years\[average age (57.6±21.3) years\] developed SIADH. The dosage and administration were as follows: an initial dose of pituitrin 6 U was given via a Murphy’s dropper, followed by 3~6 U/h via an infusion pump. After hemorrhage ceased, the dosage of pituitrin was decreased. The durations of treatment were 2~9 days. A cumulative dose was 76~800 U. Hyponatremia occurred in 36 days after starting pituitrin use. Thirty one patients (34.83%) were mild hyponatremia (serum sodium>120~130 mmol/L), 49 patients (55.06%) were moderate hyponatremia (serum sodium >110~120 mmol/L), and 9 patients (10.11%) were severe hyponatremia (serum sodium 104~110mmol/L). Sixtynine patients developed hyponatremiaassociated clinical symptoms including lassitude and asthenia in 55 cases (36.7% frequency), anorexia and nausea in 48 cases (32.0%), apathy, headache, and dizziness in 35 cases (23.3%), delirium, convnlsion, and coma in 12 cases (8.0%). After the dosage decrease or discontinuation of pituitrin, water restriction, and salt administration, 85 patients' serum sodium level return to within the normal limits, 2 patients with lung cancer died of uncontrolled pulmonary hemorrhage, and the other 2 patients developed central pontine myelinolysis (CPM) leading to upper and lower limb dyskinesia and dysphasia. Conclusion: Pituitrin might cause SIADH, and hyponatremia occurring is doserelated. Therefore, a suitable dosage of pituitrin should be the one which can just stop bleeding, and high dosage of pituitrin should be avoided if possible.
  • 论著
    Zhou Ying;Huang Lihua;Liang Yan;Jiang Guangxia;Cui Yimin
    2009, 11(1): 9-4.
    Abstract ( ) PDF ( )
    Objective: To investigate the risk of developing secondary cancer in patients who had received Chinese herbal medicines containing aristolochic acid after kidney transplant. Methods: The data from the kidney transplant recipients in our hospital were collected from January 1, 2000 to December 31, 2007. The patients were divided into the following two groups: the receiving aristolochic acid group and naive aristolochic acid group. The incidence and relative risk of secondary cancer in kidney transplant recipients in both groups were analysed. Results: The total kidney transplant recipients were 279 [147 men and 132 women, aged 16~64 years, average age(41.3±11.7) years]. Of them, twentythree patients (7 men and 16 women) with average age of (55.4±7.8) years had received Chinese herbal medicines containing aristolochic acid. Of the 23 patients, 15 developed secondary cancer after kidney transplant, and the incidence was 65.2%. The mean duration of treatment with Chinese herbal medicines containing aristolochic acid was 2.75 (0.33~29) years. Two hundred and fiftysix patients (140 men and 116 women) with average age of (39.9±11.0) years had not received Chinese herbal medicines containing aristolochic acid. Of the 256 patients, 3 developed secondary cancer, and the incidence was 1.2%. The risk of developing secondary cancer in the patients who had received Chinese herbal medicines containing aristolochic acid was about 150 times greater than that in the patients who had not received Chinese herbal medicines containing aristolochic acid (RR: 158.125, 95% CI: 38.013~657.767, P=0.000). Conclusion: The patients who have received Chinese herbal medicines containing aristolochic acid may have an increased risk of developing secondary cancer after kidney transplant.
  • 论著
    Wang Jiazhi;Liu Shumin;Zhao Yan;Tang Qing
    2009, 11(1): 13-4.
    Abstract ( ) PDF ( )
    Objective: To observe rat liver cell injury induced by diterpene lactiones extracted from Dioscorea bulbifera L. Methods:Dioscorea bulbifera pieces 3 kg were extrated with alcohol 75%, and alcoholic extract was extracted with chloroform, and then 22 g of extract were obtained; 18 g of the extract were mixed with 40 ml of Tween 80 (polysorbate 80), and then diluted with distilled water until the resulting suspension was 0.044 g/ml. Twenty SD male rates were divided into the following two groups: the extract group and the control group (10 rates in each group). In the extract group, 2.5~3 ml (dose calculation based on bodyweight, 1.19 g/kg) of the extract suspension were poured into the rats' stomach two times daily for 7 days. In the control group, the rats were given an equal volume of distilled water containing the same amount of Tween 80 two times daily for 7 days. The appearance, activity, and food intake were observed. After 7 days, the rats were weighed, liver glutathione peroxidase (GSH-PX), catalase (CAT) and superoxide dismutase levels were measured, the liver index was calculated, and the liver cell ultrastructure was observed under transmission electron microscopy. Results: Dry, brittle and dull hair, hair loss, hypoactivity, lying curled up, and reduced food intake occurred in rats in the extract group, The change rate of rat's weight in the extract and control groups was (0.929±0.032)% and (1.170±0.046)%, respectively. The difference was statistically significant(P<0.01). The liver index in the extract and control groups was 14.54±2154 and 8.602±0.170, respectively. There was statistically significant difference(P<0.01);GSH-PX, CAT, and SOD levels in the extract and control groups were (157.63±57.44) U/L and (0.92±0.61) U/L, (131.12±27.54) U/L and (375.41±46.92) U/L, (6.44±2.25) U/L and (253.05±34.84) U/L, respectively. The differences were statistically significant (all P<0.01). Ultrastructually, markedly increased lipid droplets and smooth endoplasmic reticulum, swelling and myeloid changes of mitochrondia, dissolution of surface microvilli of hepatocytes, and unclear perisinusoidal space were found in the extract group. Conclusion: The diterpene lactones extracted from Dioscorea bulbifera have liver cell toxicity. The machanism may be associated with diterpene lactoneinduced oxidative damage to hepatocellular mitochrondia.
  • 论著
    Huang Daoqiu;Li Baiqun
    2009, 11(1): 17-6.
    Abstract ( ) PDF ( )

    Objective: To study the safety and efficacy of compound moxiflocacin ear drops to experimental animals. Methods:In skin irritation testing, 20 rabbits were divided into 2 groups: the normal skin group and the damaged skin group (10 rabbits in each group). Compound moxifloxacin ear drops 1 ml and normal saline 1 ml were applied to the right and left sides in the one and same rabbit once daily for 7 days, respectively. The skin reactions were observed and scored.In skin allergy testing, 30 guinea pigs were divided into the following three groups: the compound moxifloxacin ear drops group, the 1% 2,4dinitrochlorobenzene group, and the normal saline group (10 guinea pigs in each group). The depilated areas of guinea pigs in the three groups were applied with 0.5 ml of abovementioned three medications, respectively. Allergic skin reactions were observed 6, 24, 48, and 72 hours after administration. In acute toxicity testing, 100 mice were devided into 2 groups: the subcutaneous injection group and the intraperitoneal injection group (50 mice in each group). Every group was redivided into 5 variable dosage groups: 40, 32, 26, 20, and 16 ml/kg in the subcutaneous injection group, and 32, 26, 21, 16, and 13 ml/kg in the intraperitoneal injection group. The mortality of the mice was observed for 7 days. LD50 and 95% confidence interval were calculated. In the efficacy study, 30 rabbit models of otitis media were randomly divided into 5 groups as fellows: the three variable dosage of compound moxifloxacin ear drops treatment groups, the ofloxacin ear drops positive control group, and the blank control group (6 rabbits in each group). In the three variable dosage of compound moxifloxacin ear drops treatment group, 0.8, 0.5, and 0.2 ml of compound moxifloxacin ear drops were applied into the ear three time daily, respectively. In the ofloxacin ear drops positive control group, 0.5 ml of ofloxacin was applied into the ear three times daily. In blank control group, nothing was applied. The efficacy to otitis media was evaluated one week after treatment. Results: No compound moxifloxacin ear dropsinduced erythema, swelling, and allergy were found. The subcutaneous and intraperitoneal LD50 were 25.55 ml/kg and 22.58 ml/kg for mice, respectively. The rate of high efficacy to the three variable dosages of compound moxifloxacin ear drops and the ofloxacin ear drops were 83.3%~100% and 666%, respectively, compared with the blank control group. Conclusion: Compound moxifloxacin ear drops is a safe and effective agent in treatment of otitis media.

  • 病例报告

  • 病例报告
    Jia Ning;Zhao Pengtai;Zhong Chengfu;Liu Xiaozong;Liu Ying
    2009, 11(1): 22-2.
    Abstract ( ) PDF ( )
    An 82yearold man, who had a 15year history of type II diabetes, received a longterm treatment with 5 Xiaoke pills thrice daily. The medication was changed to diformin 0.25g twice daily three months ago. The man experienced fatigue in recent one week. Unconsciousness, spasm of extremities, convulsion, upward eye deviation, and trismus occurred abruptly five hours before admission. Physical examination showed light coma, hypermyotonia in his neck and extremities, bilateral positive Babinski sign. His blood glucose level was 1.70 mmol/L; his brain CT scan only revealed senile brain changes. Hypoglycemic coma was diagnosed. The patient was infused with 500ml of glucose injection 10% intravenously at once. Thirty minutes later, his convulsion ceased and his consciousness recovered gradually. Diformin was stopped and acarbose was given. His blood glucose level fluctuated between 5.6~10.8 mmol/L and his hypoglycemia did not reappear.
  • 临床观察

  • 临床观察
    Wang Lina;Qi Xiaolianb;Gao Rana
    2009, 11(1): 23-5.
    Abstract ( ) PDF ( )
    Objective: To observe the safety of prolonged treatment with high blood phenobarbital concentration for acute encephalitis with refractory, repetitive partial seizures (AERRPS). Methods: Between July 2003 and September 2008 the inpatients with encephalitis, who met the Sakuma diagnostic criteria for AERRPS in 2001, were enrolled in this study. The dosage and administration were as follows: an intravenous or intramuscular injection of phenobarbital 200 mg, followed by an IV infusion of 1~1.5 mg/(kg·h) or an intramuscular or intravenous injection of 200 mg every 2~4 hours. The total daily dosage was 1.2~2.4 g. The blood phenobarbital concentration reached 100 μg/ml in about 24 hours. The high blood phenobarbital concentration was maintained for 24~100 days. During the treatment with high blood phenobarbital concentration, the patients’blood pressure, heart rate, heart rhythm, respiration, skin disorders, consciousness, pupils, and seizures were observed. The routine blood test and biochemical analysis were performed. Prolonged EEG monitoring was conducted. The observation on outcome was at least 6 months. Results: During the treatment with high blood phenobarbital concentration, 5 patients were in coma status, the Glasgow coma scales were scored 3~5. No burstdepression pattern was found under an EEG monitoring. Most of brain stem reflexes remained and spontaneously breathing disappeared. Three cases of sinus tachycardia, 2 cases of ventricular tachycardia or supraventricular tachycardia occurred. Two patients' blood pressure decreased to 64~84/40~55 mmHg. Five patients’ALT, AST, and γGT levels were 57~385 IU/L, 38~365 IU /L, and 54~542 IU /L, respectively. The blood ammonia level increased to 103.7 μmol/L. The severity of skin dosorders was mild. Renal function was not affected by the treatment. When blood phenobarbital concentration decrased to < 50 μg/ml, the patients’consciousness and spontaneous breathing recovered, and adverse reactions were basically disappeared. Conclusion: Prolonged treatment with high blood phenobarbital concentration may cause severe adverse reactions. Therefore, the patients with AERRPS receiving prolonged treatment with high blood phenobarbital concentration should be given artificial ventilation and close monitoring, and the adverse reactions should be managed immediately in order to benefit the patient safety.
  • 安全合理用药

  • 安全合理用药
    Hu Zhonghui;Wang Quanjun;Liao Mingyang
    2009, 11(1): 28-3.
    Abstract ( ) PDF ( )
    Andrographolide injection (Lianbizhi injection) is an antibacterial and antiinflammatory agent. Recently, andrographolide injectioninduced acute renal injury has been reported, and its potential safety issue has caused widespread concern. The clinical feature of the renal disorder is that the latent period from exposure to onset of symptoms is short and it usually occurs after one dose. The presentations are lumbago, nausea, oliguria, anuria, and an increase in serum creatinine and urea nitrogen. The experimental study has suggested that andrographolide injection has no marked toxic effects on the renal tissue of rats, but administration of large dosage within a short time period may cause renal injury to some extent. Andrographolide injectioninduced nephrotoxicity may be associated with its potential toxicity or allergic reactions. In addition, high concentration or andrographolide injection combined with nephrotoxic drugs may produce renal injury. Clinicians should be aware of the previous allergic history of the patients before the drug use. The concentration and the delivery rate of infusion should be appropriate. Using andrographolide injection in combination with other nephrotoxic drugs should be avoided. The drug should not be used for patients with renal diseases.
  • 安全合理用药
    Wang Mengran;Li Min
    2009, 11(1): 31-4.
    Abstract ( ) PDF ( )
    Rosiglitazone is a thiazolidinedione oral antidiabetic that improve insulin sensitivity and is used for the treatment of type 2 diabetes mellitus. In recent years, cardiovascular events associated with rosiglitazone cause concern. A meta analysis showed that in the rosiglitazone group, as compared with the control group, the odds ratio for myocardial infarction was 1.43 [95% confidence interval (CI) 1.03 to 1.98, P=0.03], and the odds ratio for cardiovascular death was 1.64 [95%CI 0.98 to 2.74, P=0.06]. The study has suggested that rosiglitazone may increase the risk of myocardial infarction and cardiovascular death. However, recently, an interim study of RECORD showed that 49 cases of myocardial infarction occurred in the rosiglitazone group, and 40 in the control group (P=0.34); congestive heart failure was 47 cases and 22cases in the rosiglitazone and the control groups, respectively (P=0.003). The study has suggested that rosiglitazone may not increase the risk of myocardial infarction and cardiovascular death, but may increase the risk of congestive heart failure. In addition, FDA issued a new Medication Guide and Prescribing information for rosiglitazone in 2008, and rosiglitazone is contraindicated in patients with severe heart failure. Therefore, the use of rosiglitazone should be based on balanced riskbenefit estimation and the dose should be individualized.
  • 中毒救治

  • 中毒救治
    Xu Jing;Zhu Weiguo;Wang Dixin
    2009, 11(1): 35-2.
    Abstract ( ) PDF ( )
    The traditional Chinese medicine Xiaoerqizhen pills, which contain realgar and cinnabar, are used for treatment of acute infantile convulsion and constipation. This paper reports that two adults developed chronic arsenic poisoning after prolonged use of highdose Xiaoerqizhen pills.Patient 1, a 36yearold woman, received 40~80 Xiaoerqizhen pills once daily for three years for constipation. Two to three months after starting Xiaoerqizhen pills use, she developed fatigue, anorexia, and dark skin pigmentation on her abdomen. In recent one year, she developed dizziness, headache, insomnia, and numbness of her limb ends. After admission, an examination showed pigmentation on his face, trunk, and extremities, pachyderma on palms and soles. Her blood arsenic level was 7.3 μg/L, and her urine arsenic level was 0.117 mg/L. Chronic arsenic poisoning was diagnosed. After completing three courses of therapy with sodium dimercaptopropane sulfonate, her symptoms markedly improved.Patient 2, a 40yearold man, received 20~80 Xiaoerqizhen pills one to two times daily for 7 years for constipation. During the treatment, he gradually presented with fatigue, anorexia, nausea, abdominal distension, pigmentation over his entire body, severe keratodermia, and numbness of extremities, hepatoemegaly, splenomegaly, and anemia. His urine arsenic level was 4.28 mg/L. He was diagnosed with chronic arsenic poisoning. After completing five courses of therapy with sodium dimercaptopropane sulfonate, his symptoms were markedly improved and he was discharged.
  • 中毒救治
    Cui Jing;Wang Jingwen
    2009, 11(1): 37-3.
    Abstract ( ) PDF ( )
    A 26yearold woman ingested 70 colchicine 0.5 mg tablets or more in a suicide attempt. Three hours later, she developed nausea, vomiting, abdominal pain, and diarrhea. Ten hours later, she was given an emetic and gastric lavage. After 3 days, she presented with a fever of 39℃, muscular pain, and abdominal pain. Laboratory values include: WBC 0.7×109/L, PLT 7×109/L, ALT 94 U/L, AST 398 U/L, ALB 25 g/L, CK 4 723 U/L, CK-MB 169 U/L, LDH >1 000 U/L,α-HBDH 1 837 U/L, BUN 4.09 mmol/L, SCr 76 μmol/L, potassium 2.66 mmol/L, calcium 1.6 mmol/L, phosphate 0.14 mmol/L, serum myoglobin 217 μg/L. The woman was diagosed with colchicine poisoning. Multiorgan system failure occurred. Filgrastin, platelet transfusion, correction of electrolyte, IV fluid, and other symptomatic therapy were given. After 21 days of treatment, her body temperature and laboratory values retured to normal except paralysis of bladder sphincter and periperal paresthesia and she was discharged.
  • 病例报告

  • 病例报告
    Zhou Changfu;Zhang Aixiang
    2009, 11(1): 39-2.
    Abstract ( ) PDF ( )
    A 50yearold man with a cold and fever received cefalexin 0.25 g capsules thrice daily and metamizole sodium 0.5 g tablets thrice daily. His temperature returned to normal after administration. The next day, the man developed erythema, skin rash with pruritus over his entire body, followed by blister with burning pain. His temperature increased again, and peaked at 40 ℃. After hospitalization, physical examination showed erythema and blister on his face, trunk, and extremities, damaged skin involving 50% of his body surface area, severe conjunctive congestion. Laboratory examination revealed the following values: WBC 18.9×109/L,N 0.78,L 0.12,M 0.10 and ALT 74 U/L. He was diagnosed with toxic bullosa epidermalysis. Cefalexin and metamizole sodium were discontinued immediately. He was treated with dexamethasone, ketotifen, cefoperazone sodiumsulbactam sodium, diammonium glycyrrhizinate. His damaged skin improved to some extent and his temperature decreased to 38.5 ℃. On day 6 after admission, the patient restarted receiving metamizole sodium 0.5 g tablets twice daily for a fever. His erythema became aggravated. The medication was withdrawn immediately. Antianaphylactic therapy was given again. Ten days later, his skin symptoms subsided.
  • 滥用误用

  • 滥用误用
    Pang Yi;Wang Jinzhong;Qin Xiaolan
    2009, 11(1): 40-3.
    Abstract ( ) PDF ( )
    Both Chuanwu (parent root of Aconitum carmichaeli) and Caowu (tuberous root of Aconitum kusnezoffii) contain diterpenoid alkaloids, of which the main alkaloid is aconitine. Inappropriate use of Chuanwu or Caowu may cause intoxication. Oral aconitine 3 to 5 mg may produce fatalities. This paper reports a case of Chuanwu and Caowu decoctioninduced cardiotoxicity. A 42yearold man developed numbness of the extremites, palpitation, chess distress, and dizziness one hour after taking 1 000 ml of a decoction prepared from Chuanwu 30 g and Caowu 30 g for external application by mistake. One hour and half , the patient presented with ventrcular extrasystole. He underwent gastric lavage, and received IV furosemide and IV omeperazole. After two hours, he developed mild coma, and muscular tremor. His heart rate was 209 beats/min, and his BP was 67/25 mm Hg. An ECG revealed ventricular tachycardia and ventricular fibrillation. IV amiodarone, IV lidocaine, and IV atropine were given. After 3 hours, laboratory testing revealed the following values: WBC 12.4×109/L, Hb 152 g/L, AST 812 U/L, and ALT 205 U/L. An ECG showed frequent ventricular extrasystole, paroxysmal ventricular tachycardia. Treatment included administration of dexamethasone, dopamine, lidocaine, Shengmai injection, Dahuang (rhubarb) decoction, and detoxication decoction prepared from black soybean, Fangfeng(ledebouriella root), mel, and Zhi Gancao (prepared liquorice). Six hours later, he became conscious. Three days later, an examination revealed HR 70 beats/min, R 17 times/min, SaO2 100%, AST 49 U/L,ALT 85 U/L. An ECG was normal. He was discharged 5 days later.
  • 病例报告

  • 病例报告
    Jiang Qingweia;Li Jianb;Chen Shuchangc
    2009, 11(1): 47-3.
    Abstract ( ) PDF ( )
    A 73yearold man received a prolonged treatment with warfarin after undergoing mitral valve replacement, and his international normalized ratio(INR) was maintained between 2.0~3.0. The patient received capecitabine chemotherapy due to stomach cancer. During the second cycle of the chemotherapy, he developed hemorrhagic blisters on his feet, nose bleeding, ecchymoses on his buttock, melena, and gross hematuria, and his INR increased. Warfarin was withdrawn immediately. Bleeding stopped after administration of fresh frozen plasma replacement and vitamin K1. The INR was maintained between 1.5~2.5 after the dosages of warfarin and capecitabine were decreased, and the chemotherapy continued and no further bleeding occurred. The increased anticoagulant effect of warfarin may be associated with the capecitabineinduced suppression of cytochrome P450 2C9 isoenzyme. A review of the literature indicates bleeding occurring in patient receiving warfarin plus capecitabine usually is within 2~6 weeks after initiation of the combined chemotherapy. The most common hemorrhage is gastrointestinal bleeding. In order to avoid bleeding occurring, prothrombin time (PT) and INR should be closely monitored, and the dosage of warfarin should be individualized.
  • 病例报告
    Han Haixiao;Li Junxiang;Jiang Yidun;He Lingyan
    2009, 11(1): 49-2.
    Abstract ( ) PDF ( )
    A 76yearold woman was administered with of oral levofloxacin 0.2 g twice daily for 5 days and levofloxacin eye drops for 1 week after undergoing cataract extraction. Two weeks later, the woman presented with asthenia, jaundiced skin and sclera, dark urine, abdominal distension, and anorexia. Laboratory investigations revealed the following levels: ALT 1 645 U/L,AST 885 U/L,γ-GT 198 U/L,ALP 155 U/L,TBil 68.9 μmol/L,DBil 42.8 μmol/L,IBil 26.1 μmol/L,ALB 33.9 g/L,APTT 41.8 s. She had no history of liver disease previously. Serological tests for hepatitis virus, cytomegalovirus, EB virus, rubella virus, and IgM of Coxsackie virus were negative; serological tests for antinuclear antibody and antimitochondrial antibody were negative. Other causes of liver damage were excluded. After 3 weeks of treatment with reduced glutathione, ursodesoxycholic acid, Yinzhihuang injection, and vitamin B complex, her jaundice markedly subsided and liver function tests showed the following: ALT 51 U/L,AST 33 U/L,γ-GT 79 U/L,ALP 102 U/L,TBil 19.2 μmol/L,DBil 5.8 μmol/L,IBil 13.2 μmol/L,ALB 42.1 g/L.
  • 病例报告
    Xie Fujun;Chen Yanqiu
    2009, 11(1): 50-2.
    Abstract ( ) PDF ( )
    A 55yearold man, who had a 2year history of type 2 diabetes and 4year history of hypertension, treated with repaglinide 2 mg thrice daily, acarbose 50 mg thrice daily, diformin 500 mg thrice daily, sustainedrelease nifedipine 30 mg once daily, and fosinopril 10 mg once daily. Rosiglitazone 4 mg once daily was added to his regimen and repaglinide was increased from 2 mg thrice daily to 3 mg thrice daily due to poor control of his blood glucose. After one week of treatment, he developed epidermal sclerosis, dehiscence, and excoriation with pain on his palms and soles. Exfoliative keratolysis was diagnosed. Exfoliative kerotolysis was considered to be rosiglitazoneassociated. Rosiglitazone was withdrawn and other drugs were continuous. The patient was given vitamin C and vitamin B complex. His excoriation improved 3 days later, and the condition of his skin normalized 3 weeks later.
  • 病例报告
    Liu Haiyana;He Meiyanb;Wang Yafengc
    2009, 11(1): 52-2.
    Abstract ( ) PDF ( )
    A 42yearold woman, who was coinfected with chlamydia and mycoplasma, started receiving minocycline herself with an initial dose of 0.2 g, followed by 0.1 g every 12 hours. After 5 days of treatment, the patient developed lumbago. On day 6, the drug was stopped. Her symptom was relieved. On day 7, minocycline was restarted. On day 10, she experienced fever, severe headache, and gross hematuria. The following day, chest distress, short of breath, and dry cough occurred. Minocycline was discontinued. Routine blood test revealed the following: WBC 10.08×109/L and N 0.73. Urinalysis revealed 78 WBCs per highpower field, erythrocytes (+++), and protein (+++). After admission, a CT scan revealed diffuse infiltration in her right upper lung lobe and bilateral pleural effusion. Mecillinam, ligustrazine and azitromycin were administered intravenously successively. His chest pain and chest distress improved to some extent. Pulmonary allergy vasculitis was diagnosed. Dexamethasone and chlorpheniramine were given. Symptoms further improved. Ten days after hospitalization, a CT scan revealed her foci in both lungs and pleural effusion disappeared. In addition, a renal biopsy revealed IgAnephropathy. She was treated with dexamethasone, aspirin, dipyridamole, benazepril, and ligustrazine. One month later, urinalysis showed that her protein and occult blood were negative.
  • 病例报告
    Zhang Haiying;Shi Xiaowei;Li Yuzhen
    2009, 11(1): 53-3.
    Abstract ( ) PDF ( )
    A 59yearold man with hepatitis C was given IM interferon α1b 3,000,000u once every other day and oral ribavirin 300mg twice daily. After about six weeks of treatment, the man experienced severe dry cough and dyspnea. He had a temperature of 36.3℃ and a WBC of 7.72×109/L with N 0.82. Blood gas analysis revealed the following: PCO2 36 mmHg,PO2 48 mmHg and SaO2 87%. Chest Xray showed increased pulmonary markings over both lungs and a patchy nubilous shadow in lower field of right lung. Chest CT plain scan revealed bilateral lung diffuse effusion with atelectasis in lower lobe. Interstitial pneumonia was diagnosed. The patient’s adverse reaction was considered to be possibly interfereon and ribavirinassociated. The medications were discontinued. The patient was treated with azithromycin and ceftriaxone. His respiratory tract symptoms rapidly resolved one day later.
  • 病例报告
    Li Zhaowu;Li Yafang;Liu Xingfen
    2009, 11(1): 55-1.
    Abstract ( ) PDF ( )
    A 38yearold woman was hospitalized with cholecystolithiasis and acute episode of chronic cholecystitis. The woman was given an IV infusion of ceftriaxone sodium 2.0 g dissolved in 250ml of sodium chloride injection 0.9%. After about 150ml of the infusion, she experienced tetany and dysphoria. Her blood calcium level was 1.85 mmol/L; her blood sodium level, blood potassium level, liver and renal function, and blood glucose level were within normal limits. Ceftriaxone sodium was withdrawn immediately. Antianaphylactic and symptomatic treatment showed no improvement in her symptoms. The patient was administered with 10 ml of calcium gluconate 10% diluted in 20ml of glucose 25% by intravenous injection. Fortyfive minutes later, the abovementioned symptoms resolved gradually; eight hours later, her blood calcium level incrcased to 2.35 mmol/L. The next day, ceftriaxone was replaced with ampicillin and the described above symptoms did not reappear.
  • 病例报告
    Wang Nan;Ni Jianghong;Zhou Xiaodong;Xie Xuejian;Zhang Zheng
    2009, 11(1): 56-2.
    Abstract ( ) PDF ( )
    A 48yearold man with hyperthyroidism took propylthiouracil 100 mg once daily for 5 years or more. He developed leukopenia during treatment. Despite treatment with drugs used in leukopenia, his leucocyte level was still lower than the normal range. Recently, the man presented with dry cough, fever, and chill. His body temperature peaked at 39.6℃. Penicillin was administered for 3 days, but his fever remained. A chest CT scan revealed inflammation of the lungs. He was treated successively with ceftriaxone and azithromycin, but his cough and fever still remained. After admission, his temperature was 38.3℃, and laboratory investigations revealed the following levels: CRP 98.0 mg/L, ASO 505.0 U/ml,high sensitivity CRP 84.2 mg/ml, IgG 18.9 g/L, immunoglobulin κ light chain 16.7 g/L,CA125 108.9 U/ml,antiendothelial cell antibody (AECA) titre 1:10,antinuclear antibody titre 1:320, His antineutrophil cytoplasmic antibody was positive. Pulmonary smallvessel vasculitis was considered to be propylthiouracilassociated. The medication was withdrawn. IV levofloxacin, IV cefoperazonetazobactam, and oral prednisone were administered. Three days later, his symptoms markedly improved.
  • 病例报告
    Cao Yuean;Peng Chaosheng;Long Nanzhan
    2009, 11(1): 58-2.
    Abstract ( ) PDF ( )
    A 52yearold man with hypertension, who had been receiving oral valsartan 80 mg daily for six years or more, underwent intracoronary stent implantation for coronary atherosclerosis. Clopidogrel tablets 75 mg/day, aspirin entericcoated tablets 100 mg/day, isosorbide mononitrate sustainedrelease tablets 40 mg/day, and atorvastatin calcium tablets 10 mg/day were given after surgery. Approximately one month later, bisoprolol 5 mg/day was added to his regimen due to palpitation. After 3 days of treatment, the man developed dry cough. His routine blood test, chest Xray, and echocardiography were normal. Symptomatic treatment showed no marked effect. Bisoprolol was discontinued and his cough improved three days later. Five months later, the patient restarted receiving bisoprolol due to palpitation, and his cough reappeared. Codeine was given, but this had no effect on his congh. Bisoprolol was stopped again. One week later, his symptom diappeared.
  • 病例报告
    Chen Guoqing
    2009, 11(1): 59-1.
    Abstract ( ) PDF ( )
    A 52yearold woman with calculous cholecystitis received an IV infusion of enoxacin glyconate 0.2 g twice daily. She had no history of diabetes mellitus. Her blood glucose level was normal before therapy,but it was elevated on day 2 of therapy. Despite treatment with insulin, there were no good results. Her blood glucose level fluctuated between 10.20~11.20 mmol/L. Enoxacin glyconate was discontinued and other medications remained unchanged. Her blood glucose level normalized gradually.
  • 病例报告
    Wu Xiaoxiong;Zhu Shijie
    2009, 11(1): 60-2.
    Abstract ( ) PDF ( )
    A 53yearold woman received 6 cycles of chemotherapy with paclitaxel and carboplatin after undergoing radical operation of endometrioid adenocarcinoma of right ovary. Each cycle lasted 21 days. On day 1 of each cycle, she was given an IV infusion of paclitaxel 270 mg and an IV infusion of carboplatin 700 mg, respectively, followed by a rest period of 20 days. After the third cycle of chemotherapy, the patient developed feet numbness. During 4~6 cycles, she presented with exacerbated feet numbness, and lower extremities weakness that made standing and walking difficult. Despite administration with vitamin B complex tablets and mecobalamin injection, her symptoms did not disslove. The adverse reactions were considered to be paclitaxel and carboplatininduced. The patient was treated with an IV infusion of timopentin 1 mg once daily, an IV infusion of compound Kushen injection 15ml once daily, oral vitamin B6 60 mg twice daily and a Chinese herbal decoction. Fifteen days later, his symptoms were relieved.
  • 病例报告
    Ma Jin;Zhong Yong
    2009, 11(1): 62-2.
    Abstract ( ) PDF ( )
    Two patients developed corneal ulcer following use of tobramycindexamethasone eye drops.Patient 1, a 54yearsold man with neovascular glaucoma and central retinal vein occlusion in his right eye, underwent glaucoma valve in plantatim. Postoperatively, one drop of tobramycindexamethasone eye drops as instilled into his operated eye every one hour. On day 7, superficial oval ulcer with grey edema along its edge occurred in the temporal part of corneal limbus in his right eye. The ulcer depth was onethird of corneal thickness. Swab cultures were negative for bacteria and fungi. Corneal ulcer was considered to be tobramycindexamethasone eye dropsinduced. The eye drops were discontinued immediately, and recombinant bovine basic fibroblast growth factor eye drops, sodium carboxymethylcellulose eye drops, vitamin C tablets, and vitamin B2 tablets were given. Two days later, his corneal ulcer was complete healing.Patient 2, a 28yearsold woman with traumatic cataract and subluxation of lens in her left eye, underwent cataract extract and intraocular lens implanation in her left eye. After surgery, one drop of tobramycindexamethasone eye drops was instilled into her operated eye every one hour. On day 3, a beltlike ulcer with grey oedema along its edge occurred in temporal part of corneal limbus in her left eye. The ulcer depth was twothird of corneal thickness. Swab cultures were negative for bacteria and fungi. Tobramycindexamethasone eye drops were stopped as the drops were suspected as a causative factor for the corneal ulcer. Recombinant bovine basic fibroblast growth factor eye drops, sodium carboxymethylcellulose eye drops, vitamin C tablet, and vitamin B2 tablets were administrated. After 3 days, her corneal ulcer was complete healing.
  • 病例报告
    Xiang Pan;Wang Fang;Wang Yu;Li Ping
    2009, 11(1): 64-1.
    Abstract ( ) PDF ( )
    A 73yearold man, who had 20 years or more history of hypertension, was treated with oral sustainedrelease nifedipine, furosemide, spironolactone, and aspirin. Subsequently captopril 12.5mg thrice daily was added to his regimen due to elevated blood pressure. After 3 days of therapy, he developed spitting up water on drinking, eating difficulties with cough and nausea. A gastroscopy showed marked edema of epiglottis. Captopril was withdrawn and his remaining medications were continued. Two days later, his drinking and eating normalized; his cough improved.
  • 病例报告
    Li Nan;Yang Bilian;Li Yuanwen;Sun Zhanxue
    2009, 11(1): 65-1.
    Abstract ( ) PDF ( )
    A 68yearold man with hypertension, who had been receiving valsartan 80 mg once daily for 1 year, took terbinafine 0.25 g once daily for onychomycosis. After twenty days of treatment, the man developed hypogeusia. After twelve weeks of treatment, he lost all sense of taste. Terbinafine was discontinued. Two months later, his sense of taste returned to some extent.
  • 病例报告
    Duan Liling
    2009, 11(1): 66-1.
    Abstract ( ) PDF ( )
    A 22yearold man underwent debridement and suture for wound on his right forehead. After surgery, the man was administered with desensitization injections of tetanus antitoxin (TAT) due to a positive TAT skin test. Fifteen minutes after the first intramuscular injection of TAT 150 U, he presented with mild itching on his trunk without skin rash. And about two minutes after the second intramuscular injection of TAT 300 U, the patient developed dizziness, blurred vision, and chest distress. He was placed in the supine horizontal position immediately. Physical examination showed a temperature of 37.5℃, a pulse rate of 74 beats/min, a respiratory rate of 20 breaths/min, a BP of 40/20 mmHg, consciousness, pale face, cold extremities, and muffled heart sound with an HR of 74 beats/min. Anaphylactic shock was diagnosed. He was administered oxygen inhalation therapy immediately, followed by adrenalin, promethazine, anisodamine, dexamethasone, calcium gluconate, dextran 40, and sodium bicarbonate. His condition normalized five hours later.
    KEY WORDS
  • 病例报告
    Gao Linan;Zhao Yinga;Wang Xinyuea;Shi Aixinb;Sun Fuchenga
    2009, 11(1): 67-2.
    Abstract ( ) PDF ( )
    Two female patients with rheumatic heart disease developed shock following infusion of amiodarone.The first patient, a 47yearold woman with rheumatic heart disease, received an IV infusion of amiodarone 150 mg diluted in 100 ml of glucose 5%. After about 70 ml of the infusion, the patient developed chest distress, restlessness; her blood pressure decreased to 59/32 mmHg and heart rate was 116 beats/min. Amiodarone was stopped. She was treated with IV dopamine 10 mg. Twenty minutes later, her blood pressure gradually returned to 100/70 mmHg and her heart rate was 110 beats/min.The second patient, a 62yearold woman with rheumatic heart disease, received an IV infusion of amiodarone 150 mg diluted in 100 ml of glucose 5%. After two minutes of the infusion, the patient developed numbness of her lips, chest distress, short breath, a feeling of fullness of the head. Amiodarone was withdrawn and changed to an infusion of sodium chloride 0.9%. Her symptoms were exacerbated. The patient presented with pale, cyanosis, restlessness; her blood pressure decreased to 50/0 mmHg and her heart rate was 140-170 beats/min. The patient was treated with IV dexamethasone 2 mg and IV dopamine 10 mg successively, and then an IV infusion of dopamine 20 mg diluted in 100 ml of sodium chloride 0.9%. Twenty minutes later, her blood pressure gradually returned to 90/50 mmHg and her heart rats was 118-160 beats/min. The patient's symptoms improved.
  • 中药不良反应

  • 中药不良反应
    Cheng Sheng
    2009, 11(1): 69-2.
    Abstract ( ) PDF ( )
    A 34yearold woman with chronic pelvic inflammation took 4 Jingangteng 0.5 g capsules thrice daily and Danefukang paste 10 g twice daily. The woman had no previous history of drug allergy and chronic liver disease. After 17 days of treatment, she developed yellowish skin and sclera, nausea, vomiting, abdominal distention, and anorexia. Her liver function tests showed the following values: ALT 828 U/L, AST 768 U/L, TBil 222.1 μmol/L, DBil 100.8 μmol/L, and TBA 283.0 μmol/L. Her jaundice persisted after admission. Her total bilirubin level peaked at 273.4 μmol/L. Her PTA and INR levels were 45.6% and 1.63, respectively. A liver biopsy revealed patchy necrosis in hepatic lobules, severe piecemeal necrosis and bridging necrosis in portal areas. Druginduced severe hepatitis was diagnosed. The two medications were stopped. The patient was given liverprotective and supportive treatment, and plasmapheresis therapy. After 12 weeks of hospitalization, her laboratory testing revealed the following: ALT 49 U/L, AST 47 U/L, TBil 52.0μmol/L, DBil 44.3μmol/L, and TBA 37.9μmol/L. Three months after discharge, her liver function returned to within normal range.
  • 中药不良反应
    Liu Qing;Wen Liping
    2009, 11(1): 70-2.
    Abstract ( ) PDF ( )
    A 17yearold girl received a Jiuhuazhichuang suppository for her anal fissure. About 23 minutes after starting administration with the suppository, the girl abruptly developed pruritus, lip swelling, and wheal of various sizes on her skin. After hospitalization, she was treated with IM dexamethasone 10 mg, IV 10% calcium gluconate 10 ml diluted in 50% glucose 20 ml. Her Jiuhuazhichuang suppository was eliminated with rectal administration of a Kaisailu (20 ml of a glycerin solution). Later, she experienced generalized asthenia and unconsciousness, her pulse rate was 108 beats/min, her respiratory rate was 30 breaths/min, and her BP was 70/48 mmHg. IM 0.1% adrenaline 0.3 ml and IV fluids were given immediately. Four hours later, the symptoms completely disappeared. An examination showed a pulse rate of 70 beats/min, a respiratory rate of 18 breaths/min, and a BP of 120/80 mm Hg.