- ISSN 1008-5734
- CN 11-4015/R
- 1999年创刊
- 主管: 中国科学技术协会
- 主办: 中华医学会
Objective: To analyze the hepatorenal damage and risk factors in moderate heroindependent patients. Methods: The moderate heroindependent patients who abused heroin<2.0 g/d in the last week and whose scores of the abstinence syndrome were 65～140 entered the study. The liver function indices in 1 455 cases, renal function indices in 1 407 cases, and risk factors were analysed retrospectively. Results: The percentages of abnormal ALT, AST, TBil, BUN, and Cr levels were 45.43%, 38.63%, 17.11%, 6.25%, and 4.12%, respectively. Multivariate Logistic regression analysis showed that risk factors for abnormal ALT were sex, duration and route of drug abuse (OR was 0.653, 1.150, and 2.263, respectively); and risk factors for abnormal AST were sex and route of drug abuse (OR was 0.692 and 2.447, respectively). Conclusion: The severity of liver damage is higher than that of renal damage in moderate heroin-dependent patients. The risk for abnormal ALT is higher in the patients with a longer term of abuse. The risk for abnormal ALT and AST in male patients and intravenous route administration is higher than in female and other route of administration .
A 47yearold man with hepatitis B was given atorvastatin 20 mg once daily and clopidogrel 75 mg once daily after undergoing percutaneous transluminal coronary angioplasty and stent implantation. About 3 months later, the patient was admitted to our hospital with fatigue, anorexia, and dark urine. Laboratory tests showed the following values: ALT 2 549 U/L, AST 1 621.7 U/L, TBil 42.3 μmol/L, and HBV DNA 8.41×105 copies/ml. Atorvastatin was discontinued, and clopidogrel was continued. He received liverprotective treatment. Four weeks later, his symptoms improved gradually, and his ALT, AST, TBil, and HBV DNA levels were 73.9 U/L, 51.8 U/L, 22 μmol/L, and <500 copies/ml, respectively.
Objective: To analyse risk factors for severe drug eruption induced by carbamazepine in clinical practice in order to decrease its development. Methods: The clinical data of 55 inpatients with carbamazepineinduced drug eruption were collected from 1997 to 2007. Of the 55 patients, 28 were nonsevere eruption and 27 were severe eruption. The relationship between the severe eruption and the age, sex, allergic history, epilepsy, initial dosage of carbamazepine, and latent of eruption was analyzed. Other adverse reactions were compared between the two groups. Results: The relationship between the severity of drug eruption and the age, sex, allergic history, and epilepsy was not found (P>0.05). It was linked to initial dose of carbamazepine and longer latent period of eruption. And there were differences in the initial dosage of carbamazepine and the latent period of eruption between the severe eruption group and the nonsevere eruption group. The initial dosage of carbamazepine was (155.74±81.130) mg/d and (124.11±44.867) mg/d（P<005）, respectively. The latent period of eruption was (11.81±7.45) days and (6.14±5.30) days (P<0.01). The severity of liver damage in patients with severe eruption is greater than that in patient with nonsevere eruption (P <0.01). The condition of patients with a fever occurring in the early stage was severe. Conclusion: The high initial dose of carbamazepine and long latent period of eruption may increase the drug eruption intensity.
Objective: To observe and evaluate the safety of topotecan and hydroxycamptothecine in treating patients with brain metastatic carcinoma. Methods: Eightysix patients clinically diagnosed as having brain metastatic carcinoma entered the study from April 2004 to December 2007. The primary carcinoma of the patients was small cell lung carcinoma (26 cases), nonsmall cell lung carcinoma (32 cases), and mammary cancer (28 cases). The 86 patients were randomly divided into two treatment groups: the topotecan group (44 cases) and the hydroxycamptothecine group (42 cases). The patients in the topotecan group were treated with topotecan 0.8～1.0 mg/(m2·d) in 100～150 ml of sodium chloride 0.9% or glucose 5%, by intravenous infusion within 30 min on day 1～5. The patients in the hydroxycamptothecine group were treated with hydroxycamptothecine 4.0～6.0 mg/(m2·d) in 100～150 ml of sodium chloride 0.9% or glucose 5%, by intravenous infusion within 30 min on day 1～5. The chemotherapy was 2 cycles, and one cycle was 21 days. The curative effects were evaluated in the end of the second cycle. The response rate, clinical benefit rate, and adverse reactions were evaluated and compared between the two groups. Results: Two cycles of chemotherapy and evaluation of efficacy were accomplished in 84 cases of the two groups. The percentage of accomplishment was 97.6%. The response rate and clinical benefit rate of topotecan versus hydroxycamptothecine were 37.21 vs 36.59% and 81.40% vs 73.17%, respectively. There were no statistical differences (P>0.05). The manifestation of blood toxicity was leukocytopenia and thrombocytopenia. The leukocytopenia and thrombocytopenia in Ⅲ～Ⅳ degrees were 29.55% and 13.64% in the topotecan group, respectively, and 7.14% and 2.38% in the hydroxycamptothecine group, respectively. There were marked differences between the two groups (P<0.05). Conclusion: Low-dose topotecan and hydroxycamptothecine have a relatively good therapeutic effect, safety, and tolerance in the treatment of brain metastatic carcinoma.
Patient 1, an 80yearold woman underwent resection of bullas of the right lung and fixation of pleural friction received intravenous infusion of fat emulsion for seven consecutive weeks. Later, her TBil, DBil, and TG levels increased from 12.5 μmol/L, 3.3 μmol/L and 0.95 mmol/L to 141.5 μmol/L, 104.3 μmol/L, and 13.64 mmol/L, respectively; her PLT decreased from 189×109/L to 48×109/L. After stopping fat emulsion, her TBil, DBil, and TG levels were 46.2 μmol/L, 33.1 μmol/L, and 2.50 mmol/L, respectively; her PLT was 51×109/L. And ten day later, the patient died of circulatory and respiratory failure.Patient 2, an 89yearold man with pulmonary infection, left pneumothorax, and waterelectrolyte disturbances received intravenous infusion of fat emulsion for three consecutive weeks. Later, his TBil, DBil, and TG levels increased from 9.5 μmol/L, 4.1 μmol/L, and 1.03 mmol/L to 210.8 μmol/L, 182.1 μmol/L, and 13.96 mmol/L, respectively; his PLT level decreased from 242×109/L to 128×109/L. After stopping fat emulsion infusion, his TBil, DBil, TG and PLT level were 152.4 μmol/L, 89.3 μmol/L, 5.32 mmol/L, and 88×109/L, respectively. The patient died of multiorgan failure.
Objective: To study the tolerance and safety of moxifloxacin in the treatment of elderly patients with communityacquired lower respiratory tract infections. Methods: One hundred and ninetyseven patients with communityacquired lower respiratory tract infections ［104 men, 93 women, average age (73±11) years］ were included in the study. They received IV moxifloxacin 400 mg/d for 7～10 days, followed by oral moxifloxacin 400 mg/d for 3～6 days. The duration of treatment was about 2 weeks. The tolerance and safety of moxifloxacin were observed. Results: Twoweek therapy was accomplished in 194 patients, and the therapy was discontinued in 3 patients because of neuropsychic disorders and rash. Of the 194 patients, 135 cured perfectly, 42 improved significantly, and 17 improved. The adverse reactions occurred in 24 patients, and the main reactions were mild neuropsychic and gastrointestinal disorders. Conclusion:Moxifloxacin is a relatively effective and safe agent for treating communityacquired lower respiratory tract infections. It is well tolerated to elderly patients.
Objective: To discuss the clinical characteristics of shock induced by intravenous amiodarone in treating patients with atrial fibrillation. Methods: The clinical data of shock induced by intravenous amiodarone in treating patients with atrial fibrillation were collected from Chinese medical literature between 2003 and 2007, including the patients baseline heart diseases and the rhythm, heart rate, blood pressure, cardiac function status, and ECG changes during the period of atrial fibrillation attack. The concentration of fluid, delivery rate of intravenous infusion, and total dosage of amiodarone, and the manifestation, duration, and management of shock were analyzed. Results: The clinical data of seven patients with amiodaroneinduced shock were collected. Two of the 7 patients came from our hospital. Amiodarone was dissolved in 100 ml of glucose 5%, the concentration of amiodarone was 1.5～1.7 mg/ml, and the delivery rate was 2.5～1.0 mg/min by intravenous administration. The onset time of shock was within 2 minutes after medication in 4 cases, and from 5 to 20 minutes in 3 cases. The shock lasted from 3 to 120 minutes. Two patients accompanied with disturbance of consciousness, and five patients were still atrial fibrillation during the period of shock. Conclusion: The intravenous amiodarone might induce shock. The clinical condition is critical and it improves after immediate symptomatic treatment.
Objective: To investigate the eye disorders induced by hydroxychloroquine in treating rheumatic diseases. Methods: Eightthree hydroxychloroquinetreated patients with rheumatic diseases in our hospital were investigated from January 2003 to June 2007. The type and frequency of adverse reactions associated with hydroxychloroquine were analysed. Results: The initial dosage of hydroxychloroquine used in 83 patients was 200～400 mg/d, subsequent dosage was decreased to 100～200 mg/d. Of the 83 patients, 12 developed adverse reactions as follows: 5 cases (6.0%) of eye disorders, 3 cases（3.6%）of neurological disorders, 2 cases (2.4%) of gastrointestinal disorders, 1 case (1.2%）of skin rash, and 1 case (1.2%）of oedema. Of the 14 patients receiving visual field testing, one patient's visual field defect probably related to hydroxychloroquine, and another patient’s visual field defect possibly related to hydroxychloroquine. Conclusion: Hydroxychloroquine might induce eye disorders. It is relatively mild in severity, and improve after stopping hydroxychloroquine or decreasing its dosage.
Objective: To observe the myopathy following telbivudine alone and telbivudine plus adefovir or interferon administration and analyze its relative factors. Methods: Five patients with myopathy related to telbivudine alone and telbivudine plus adefovir or interferon in our hospital from January 2007 to January 2008 were investigated. The dosage and administration of the drugs, the clinical manifestation of myopathy, and the results of laboratory testing were analyzed. Results: The 5 patients were men aged 25～45 years. One patient received telbivudine 600 mg once daily for 1 month. One patient received telbivudine 600 mg twice daily for 2 months, and subsequent regimen was changed to telbivudine 600 mg once daily plus adefovir 10 mg once daily for 5 months. Three patients received telbivudine 600 mg once daily plus intramuscular injection of interferon 3×106 U every other day for 3～9 months, respectively. All five patients developed myalgia and generalized hypodynamia, and cardiac muscle was involved in one patient, and three patients presented with neurological disorders. Of 5 patients, 4 patients' CK levels were 311～900 U/L. Conclusion: Telbivudine alone and telbivudine plus adefovir or interferon might induce myopathy. And the dosage of telbivudine might be associated with the severity of myopathy in certain degrees.
An 89yearold man with type Ⅱ diabetes mellitus and hypertension was hospitalized with pulmonary infection. The hypoglycemia and antihypertensive agents were discontinued, and he was infused with pazufloxacin 0.3 g twice daily intravenously. After one hour of the third infusion of pazufloxacin, the patient developed a cold sweat, and his blood glucose level decreased from 10 mmol/L to 2.7 mmol/L. Pazufloxacin was discontinued immediately, and he received intravenous injection of 60 ml of glucose 50%, intravenous infusion of glucose 10%, and sufficient foods. Twentyfour hours later, his blood glucose increased to 5.6 mmol/L gradually.
A 70yearold man with upper respiratory tract infection was administered with intravenous infusion of levofloxacin 0.2 g twice daily and oral Shuanghuanglian solution 10 ml thrice daily. After the third infusion of levofloxacin, the man experienced pain of finger joints. And after the fifth infusion of levofloxacin, his painful swelling of finger joints worsened, and wrist, shoulder, elbow, and knee joints were involved; skin rash occurred. Laboratory investigations revealed the following levels: ALT 1 705 U/L, AST 754 U/L. Levofloxacin was withdrawn, and he received liverprotective and symptomatic treatment. One week later, his painful swelling of joints and skin rash resolved, his ALT level was 80 U/L, and his AST level returned to normal range.
An 87yearold woman with cerebral infarction and stress ulcer received intravenous injection of omeprazole 40 mg in 10 ml of sodium chloride 0.9%. Approximately 10 minutes later, the woman developed palpitation with a heart rate of 124 beats/min, and her ECG showed sinus tachycardia. Her symptoms resolved gradually after one hour. The next day, the abovementioned symptoms reappeared after repeated exposure to the same regimen, and relieved after one hour. Omeprazole was discontinued and changed to ranitidine. The abovementioned symptoms did not recur.
Three men, aged 38, 46, and 41 years, were infused with alginic sodium diester 100 mg once daily intravenously. Two to four days later, they developed penile erection lasting for 24～72 hours. The patients were treated with ice packs and compression to the penis, aspiration of the excess blood from the penis, irrigation of the penis using heparinised saline solution, intracavernous injection of dopamine, and oral administration of diazepam. Later, their symptoms resolved completely.
A 21yearold woman received intravenous infusion of clindamycin 0.6 g in 500 ml of glucose 5% once daily for treating hyperpyrexia. Three days later, IV clindamycin was changed to oral clindamycin 0.3 g. After taking the second oral clindamycin, she presented with skin rash over her entired body. The laboratory test revealed the following values: ALT 267 U/L, AST 176 U/L, γ-GT 202 U/L. Clindamycininduced adverse reactions were suspected. Clindamycin was discontinued, and she was treated with IV dexamethasone, vitamin C, glucurolactone, and bifendate. Twenty days later, her skin rash disappeared completely and her liver function parameters decreased, and then the patient was discharged. On reexamination, her liver function returned to normal range 3 weeks after discharge.
A 52year old woman with type Ⅱ diabetes mellitus initially treated with insulin aspart and subsequently insulin zinc protamine. About 3 months later, the regimen was changed to subcutaneous injection of insulin aspart 30 (dosage not stated). About one month later, skin rash and pruritus occurred at the injection sites. The skin disorders lasted from 2 to 3 hours, and then resolved. About further 2 months later, she presented with localized lipoatrophic areas (about 1～4 cm in diameter) at insulin aspart 30 injection sites on her forearm and abdomen. Insulin aspart 30 was discontinued, and switched to oral nateglinide 60 mg twice daily. One year later, her areas of lipoatrophy basically disappeared.
A 33yearold woman was hospitalized with viral hepatitis B, hepatic cirrhosis (compensation period), splenomegaly, and portal hypertension. The woman developed marked swelling of bilateral parotid glands and submandibular glands with mild tenderness about 20 minutes after starting intravenous infusion of tiopronin 0.2 g. Tiopronin was discontinued immediately, and her salivary glands swelling subsided gradually. Later, tiopronin was switched to diammonium glycyrrhizinate, and salivary glands swelling did not reappear.
A 30yearold woman with postpartum hemorrhage received sublingual misoprostol 600 μg. Fifteen minutes later, the patient suddenly developed dizziness, chill, breath holding, pale face, peripheral coldness, listlessness, and cold sweat. Physical examination showed a BP of 150/100 mmHg, P of 105 beats/min, R of 24 breaths/min. Misoprostolinduced anaphylactic reaction was suspected. The woman was given oxygen, antianaphylactic therapy immediately, and misoprostol was replaced with oxytocin for treating postpartum hemorrhage. Seven hours later, her symptoms were relieved.
A 26yearold man was administered IV levofloxacin 0.3 g twice daily for treatment of pneumonia. Three days later, the man experienced insomnia and temporal paraphasia. On day 5, he presented with extreme excitement, abnormal behavior, and inability to fall asleep. The patient was treated with diazepam. The next day, levofloxacin was withdrawn and his symptoms improved gradually. He regained normal status 24 hours after discontinuation of levofloxacin.
A 44yearold woman was hospitalized after she had undergone left oviducal adenocarcinoma surgery and received the fifteenth chemotherapy. On day 2 after admission, the patient was infused with paclitaxel 180 mg intravenously, and no adverse reactions occurred. On day 3, the woman was infused with cisplatin 100 mg intravenously. After about 5 minutes of infusion, she developed palpitation, nausea, chest distress, hidrosis, and disturbance of consciousness. Her blood pressure decreased from 116/74 mmHg to 74/43 mmHg. Anaphylactic shock was diagnosed. Cisplatin was discontinued immediately, and her symptoms resolved after antianaphylactic and symptomatic treatment.
A 42yearold woman, who had an over 10year history of adnexitis, took Jingangteng syrupus 10 ml thrice daily intermittently. At that period of time, the results of her liver function tests were normal. However, the patient presented with generalized asthenia and nausea after receiving Jingangteng syrupus for two consecutive years in recent years. Laboratory tests revealed the following values: ALT 525 U/L, AST 520 U/L. Serologic tests for hepatitis A, B, C, D, and E were negative. A liver biopsy was consistent with the pathologic changes in druginduced hepatic injury. Jingangteng syrupus was discontinued. After one month of liverprotective treatment, her liver function tests normalized.The authors suggest that the Jingangteng syrupusinduced hepatic injury might be associated with its longterm use, and attention should be paid for the longterm use of this drug in clinical practice.
A 40yearold woman with type Ⅱ diabetes was administered with 100 ml of IV saffloryellow sodium chloride injection for treatment of numbness of hand and foot. After about one minute of infusion, the woman experienced severe abdominal pain, facial flushing, dyspnea, skin eruption on her neck and a BP of 60/40 mmHg. The intravenous infusion was discontinued at once. Her symptoms markedly improved thirty minutes after symptomatic treatment; her BP was 100/70 mmHg and her skin eruption resolved gradually. The following day, her condition was stable.
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