- 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 compare the efficacy in treating schizophrenia and the influence on serum prolactin level of aripiprazole versus risperidone. Methods： Eighty patients with schizophrenia in our hospital from May 2005 to May 2006 were randomly divided into following two groups: the aripiprazole group (40 cases) and the risperidone group(40 cases). The initial dose in the aripiprazole group was 10 mg/d, and subsequent dose was increased to 20～30 mg/d in the end of 2 weeks. The initial dose in the risperidone group was 1 mg/d, and subsequent dose was increased to 4～6 mg/d in the end of 2 weeks. The total duration of treatment was 8 weeks. The curative effects and adverse reactions in the two groups were evaluated with the positive and negative syndrome scale (PANSS) and the treatment emergent symptoms scale (TESS). Serum prolactin level was measured with chemoluminescence technique. Results：The effective rate in the aripiprozole and risperidone groups was 72.5% and 77.5%, respectively. There was no significant difference between the two groups (P>0.05). The principal adverse reactions in the aripiprazole group were drowsiness, headache, gastrointestinal disorders, and akathisia; lactation and amenia were not found. The main adverse reactions in the risperidone group were acute myodystonia, tremor, akathisia, lactation or amenia, and weight gain. Serum prolactin level after 8 weeks of risperidone treatment was higher than that before treatment. The difference was markedly significant (P<0.01). The serum prolactin level was elevated 3.5 times in male patients and 8 times in female patients. And the serum prolactin level was no changes in the aripiprazole group. Conclusion：Aripiprazole is a relatively effective and safe agent in the treatment of schizophrenia．
A 54yearold woman with duodenal bulb ulcer took esomeprazole 20 mg once daily, gefarnate 50 mg thrice daily, and hydrotalcite 500 mg thrice daily. Nearly half a month later, she developed anorexia and dark urine gradually. After another one month, she developed yellowish of sclera and pruritus. At out-patient department, her liver function examination showed the following values: AST 890 U/L, ALT 1 123 U/L, ALP 204 U/L, γ-GT 277 U/L, TBil 169.7 μmol/L, DBil 99.7 μmol/L, IBil 70.0 μmol/L，TBA 234.6 μmol/L. Esomeprazole was discontinued after admission, and the patient was treated with reduced glutathione and tiopronin. One week later, the patients yellowish of sclera resolved gradually and urine color returned to normal. On reexamination 3 weeks later, her liver function markedly improved, and then she was discharged from the hospital.
Objective: To compare the damage of auricular vein and peripheral tissue caused by mannitol and β-aescine sodium in rabbits. Methods: Twelve healthy rabbits were randomly divided into three groups with 4 rabbits in each group: the mannitol group received 5 ml of mannitol 20％ intravenously, the β-aescine sodium group received 5 ml of aescine sodium 0.02％ intravenously, the control group received 5 ml of sodium chloride 0.9％ intravenously. Each rabbit received two injections every day, ie, the left ear margin vein received the injection in the morning, and the right ear margin vein received the injection in the afternoon. The duration of medication was 3 days. The severity of damage on day 1 and day 3 and the degree of recovery on day 4～7 to the rabbits auricular vein and peripheral tissue were observed. Results: A pathological examination showed that on day 1, no marked changes in vascular and peripheral tissue of rabbit's ears were found in the mannitol and control groups, but vascular expansion and hemorrhage of rabbit's ears were found in the β-aescine sodium group. On day 3, the damage to vascular and peripheral tissue of rabbit's ears which were within 0.5 cm of the injection site was aggravated in the mannitol and β-aescine groups as follows: distruction of vascular endothelial cells, intravascular stasis and inflammatory edema of peripheral tissue occurred in the mannitol group; vascular expansion and inflammatory response occurred in the β-aescine sodium group; and no changes were found in the control group. On day 4, inflammation and edema to the peripheral tissue relieved in varying degrees in the mannitol and β-aescine sodium groups. However, on day 5 and day 7, a 1 cm×1 cm nercotic tissue which was 2 cm from the injection site, and a 0.6 cm×0.4 cm necrotic tissue which was 3.5 cm from the injection site occurred in two rabbits of the mannitol group, respectively. No necrotic tissue was found in the β-aescine sodium group. Conclusion: The appearance of damage caused by mannitol is later than that of β-aescine sodium. And severity of damage to the vascular and peripheral tissue caused by mannitol is more serious than that caused by β-aescine sodium.
Objective: To investigate the present condition of professional structure and expertise of the staffs in five adverse drug reaction (ADR) monitoring centres at provincial level in order to provide scientific basis of human resources for developing intensive medicine monitoring programme and improving ADR monitoring system. Methods: The information relative to the staffs in the five centers was investigated and collected with selfquestionnaire and qualitative interview, including the personal information, ability of monitoring and research, and expertise level. Results: Fiftythree staffs in the five centers were investigated. The number of valid questionnaires was fiftytwo.The average age was (35±8) years. The ratio of male to female was 0.93∶1. The staffs with high or middle professional title were 53.9%. The percentages of doctor, master, and bachelor were 7.7%, 32.7%, and 51.9%, respectively. The percentages of clinical medicine, pharmacy, public health, computer, and statistics, were 46.1%, 21.1%, 58%, 3.8%, and 1.9%,respectively. Most staffs lacked epidemiological and statistical knowledge. Conclusion: The professional structure and expertise of the staffs in the five ADR monitoring centres at provincial level were equal to the task of ADR monitoring. However, the centres should be staffed with some specialists of public health, statistics, and computer, and some staffs should be trained with abovementioned expertise in order to benefit the development of intensive medicine monitoring programme and improvement of ADR monitoring reporting system.
Objective: To analyze the risk factors of myelopathy induced by intrathecal methotrexate. Methods: Thirtysix patients with intrathecal methotrexateinduced myelopathy were collected from English literature between 1969 and 2007. The age and original diseases of the patients, the dosage and frequency of intrathecal methotrexate, combined drugs, myelopathy and its outcome were analyzed. Results: Thirty (83.3%) patients age was < 18 years. Thirtyfour cases stated the sigle dose of methotrexate, and 28 (77.8％) of them received methotrexate ≤15 mg, the others received methotrexate < 50 mg. Twentyseven patients received more than 5 injections. Paraplegia after first injection occurred in 2 cases. Eleven patients received methotrexate alone, and 25 patients were given methotrexate combined with cytarabine and/or dexamethasone. The time of myelopathy onset in 11 patients was within 24 hours after intrathecal injection. Flaccid paralysis involving the lower extremities or the extremities occurred in 35 patients. After treatment of highdose methylprednisolone and folic acid, 21 patients motor and sensory functions of the extremities partly or fully recovered. And 11(30.6%) patients died. Conclusion: Intrathecal methotrexateinduced myelopathy might be linked to more frequent injection and higher total dosage of methotrexate, and multiple concomitant medications.
A 5yearold boy with a cold and fever was treated with azithromycin 0.25 g dissolved in 250 ml of glucose 5% intravenously once daily for 3 days. And then he developed hypodynamia and anorexia. His ALT level increased to 351 U/L. The patients condition improved gradually after treatment with proheparin and vitamin C. Fourteen days later, his ALT level returned to normal limits. The boy was fully recovered.
Objective: To investigate the case reports of paraplegia resulting from intrathecal methotrexate administration and to analyse the factors influencing prognosis of paraplegia. Methods: Eleven case reports of paraplegia resulting from intrathecal methotrexate administration were collected from the database of Chinese medical literature between 1978 and 2007. The patients sex and age, dosage of methotrexate, combination with cytavabine, dosage of cytarabine, frequency of intrathecal injection, onset time and outcome of paraplegia were investigated. The factors influencing the prognosis were analyzed. Results: Of the 11 patients, 4 were reversible and 7 were irreversible. There was no statistical deference in sex, age, and the level of the injury to the spinal cord between reversible and irreversible cases (P＞0.05). Less frequent intrathecal injection, more rapid onset of paraplegia after the last injection, lower dosage, and fewer combination with cytarabine were found in reversible cases compared with irreversible cases. The diffences were statistically significant (P＜0.05). Conclusion: The possible causes of unfavourable prognosis were more frequent intrathecal injections, paraplegia occurring over 24 hours after the last injection, higher dosage, and combination with cytarabine.
Realgar (Xionghuang) has a history of two thousand years and more as a traditional Chinese medicine, and it was included in each edition of Chinese Pharmacopoeia from 1963 to 2005. Realgar is mainly used for treatment of snack and insect bite, parasitogenic abdominal pain, convulsions, and malaria. Recent studies suggest that realgar has antibacterial, analgesic and antiinflammatory effects as well as the effect of enhancing immunity; realgar preparations are effective for treating leukemia. The daily dosage of realgar is 0.05～0.1 g. Actually, according to incomplete statistics, the commonly used dosage of about 66 realgar preparations exceeds the dosage limit in Chinese Pharmacopoeia. The main composition of realgar is arsenic disulfide (As2S2). Despite lower toxicity of arsenic disulfide, acute or chronic poisoning can occur after high dosage or longterm use of realgar. And it might be related to soluble arsenic trioxide (As2O3) in realgar. Realgarinduced serious adverse reactions include hemorrhage, hepatorenal failure, paralysis of respiration centre, and death. The authors suggest that the scientific reassessment of its benefit and risk in clinical practice should be performed on the basis of a thorough investigation and study in the efficacy and safety of realgar and its preparations.
The common atypical antipsychotics are aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone. Sex differences are presented in the pharmacokinetics and adverse reactions of atypical antipsychotics. Because of the lower CYP1A2 activity in women, the plasma clozapine and olanzapine concentrations are higher in women than in men. Risperidone causes hyperprolactinaemia in women, which lead to higher incidence rates of osteoporosis and sexual dysfunction in women than in men. Studies suggest that the incidence rate of metabolic syndrome is higher in women than in men: the incidence rates of obesity, hypertension, hypertriglyceridemia and decreased HDL level in women and men are 76.3% vs 35.5%, 46.9% vs 47.2%, 42.2% vs 50.7%, 48.9% vs 63.3%, respectively; the incidence rates of hyperglycemia [≥100 mg/dl(5.55 mmol/L) and ≥110 mg/dl(6.10 mmol/L)] in women and in men are 30.0% vs 21.7% and 24.2% vs 14.1%, respectively. The incidence rates of prolonged QTc interval and extrapyramidal symptoms of atypical antipsychotics are higher in women than in men. Some atypical antipsychotics have adverse effects to the fetus.
A 40yearold man with pulmonary infection developed mild tinnitus after intravenous infusion of clindamycin phosphate 600 mg. Six hours later, he received the second infusion of clindamycin, his tinnitus reappeared accompanied with nausea and vomiting, and then aggravated tinnitus and lightning pain in the left face occurred. The pain repeated up to 10 times or more and lasted for several seconds to two minutes, and trigeminal neuralgia was diagnosed. Clindamycin was discontinued. Twelve hours later, his symptoms were relieved.
Enteral nutrition (EN) is defined as the administration of a nutrient solution orally or by means of a feeding tube with the purpose of contributing the supply of all or part of the body's nutrient requirements. EN preparations can be classified into three types: elemental type, non-elemental type, and module type. EN is usually given with feeding tube. Non-invasive tube includes nasogastric tube and nasointestinal tube, and invasive tube includes gastrostomy tube and enterostomy tube. Indications for EN include radical surgery in patients with upper alimentary tract or upper respiratory tract, tracheal intubation, esophageal stenosis, dysphagia, anorexia nervosa, largescale burning or trauma. Although considered safer than parenteral nutrition, enteral feeding is not of without complications. The common complications of EN were as follows: (1) mechanical complications such as obstructions of the feeding tube; (2) gastrointestinal complications are abdominal distension, nausea, vomiting, and diarrhea, and they can be reduced or avoided by using gastrointestinal pump or nasointestinal tube, reducing infusion speed, increasing nutrient solution temperature, and using gastrointestinal prokinetic drugs; (3) metabolic complications are mainly hyperglycaemia, and it can be treated with insulin; (4) infectious complications are mainly inhalation pneumonia caused by inhaling nutrient solution or regurgitation into the lungs presenting with sudden dyspnea, fever, increased heart rate. Attention should be paid to its gastric retention.
Doping is a generic name of prohibited drugs and methods defined by the International Sport Organization. Doping includes anabolic agents, peptide hormones, β2 receptor agonists, diuretics, narcotics, etc. Peptide hormone is a newer kind of doping, which includes five types: erythropoietin (EPO), human growth hormone (hGH), insulinlike growth factor-1 (IGF-1), gonadotrophins, insulin, and corticotrophins. Peptide hormones are endogenous substances of human body, so it is difficult to detect them. However, abuse and misuse of peptide hormone is harmful to human health. For example, EPO may cause anaphylaxis, hGH may cause acromegaly, IGF-1 may cause acute hypophosphatemia, gonadotrophins may cause precocious puberty in male, insulin may cause blurred vision, corticotrophins may cause amenorrhea in female, etc.
A 33yearold man with suspected urinary infection developed a dyspnea,coma,and undetectable blood pressure immediately after intramuscular injection of 2 ml of fibrauretin. Four hours after resuscitation attempts, he recovered. The patient often took fibrauretin tablets, but he did not experience anaphylaxis. However, he had experienced mild anaphylactic reactions from fibrauretin injection four years before.
A 46yearold man with ascites and abdominal cavity infection received IV Ruipuxin (cefoperazone/sulbactam)3 g without skin testing. One minute later, the patient developed a flushing in face and neck, generalized pruritus, numbness of the lips and tongue, and dyspnea. An examination revealed the following values: SPO2 0.98, BP 90/60 mmHg, and P 110 beats/min. Laryngoscopy showed laryngeal edema. Oxygen therapy and symptomatic treatment were given. One hour later, his symptoms resolved. The patient had experienced generalized prupritus after injection of Linglanxin (cefoperazone/sulbactam) a half month before.
A 66yearold man with lumbago was treated with nimesulide 100 mg twice daily. He developed jaundice and pruritus after 7 days of treatment, followed by dyspnea, oliguria, hepatorenal failure gradually. Serologic tests for viral hepatitis A, B, and C were negative. Nimesulideinduced multiorgan dysfunction syndrome was suspected. After admission, he was treated with sultamicillin, methylprednisolone, glutathione, and continuous venovenous hemofiltration. The patients condition including hepatic and renal functions progressively worsened accompanied with gastrointestinal tract hemorrhage. He died on day 4 after admission.
An 81yearold woman with pulmonary metastasis of liver cancer received oral sorafenib 400 mg twice daily. On week 4, the patient experienced a prickling on her hands, feet, and nipples accompanied with desquamation. On week 6, she presented with nausea, anorexia and an increase in number of stools. Despite a decrease in her sorafenib dosage to 400 mg once daily and symptomatic treatment, the symptoms still did not improve. On week 20, severe anorexia, marked nausea, diarrhea with 10~20 times watery stools daily and weight loss of 7 kg occurred in the patient. Sorafenib was discontinued. Two months later, her nausea resolved; her appetite improved; her daily number of stools was reduced to 2～3, and her weight loss did not occur again.
A 53yearold man who had received coronary artery bypass graft and ventricular aneurysmectomy was administered with cardiovasculcer drugs, diuretics, and antiinfective drugs. On day 3 after surgery, he developed ventricular tachycardia. The patient was administered with amiodarone 75 mg and subsequent 150 mg intravenously, and then he was infused with a minute dose of amiodarone (600 mg mixed with 50 ml of sodium chloride 0.9％) in the rate of 3 ml/h via infusion pump. On day 4～6 and on day 7 after surgery, the daily dosages of amiodarone were 864 mg and 108 mg, respectively, and they were given with a minute dose via infusion pump. Before surgery, his ALT and TBil levels were 23 U/L and 16 μmol/L, respectively. On day 7 after surgery, his ALT, AST, and TBil levels were 364 U/L, 325 U/L, and 35.8 μmol/L, respectively. On day 9 after surgery, his ALT, AST, and TBil levels were 2 667 U/L, 2 418 U/L, and 53.9 μmol/L, respectively. Amiodarone was discontinued and other medications were continued. The patient was given liverprotective treatment. His ALT, AST, and TBil levels decreased to 24 U/L, 20 U/L, and 187 μmol/L, respectively.
An 82yearold man was hospitalized with coronary heart disease, hypertension, and diabetes. After admission, he was administered with coronary vasodilators, antihypertensive drugs, and hypoglycemia agents. The patient sometimes took estazolam for a poor sleep. Later, estazolam was switched to zolpidem 10 mg at bed time. Three hours later, the patient got up, walked around, raved, and passed urine on the floor. The next day, the symptoms disappeared, and the patient had no memory of that event. Zolpidem was discontinued and estazolan was continued. The symptoms did not reappear.
A 30yearold woman underwent caesarean section was presented with a fever(37.7-39.5 ℃)from the day of surgery to day 5 after surgery. Bacterial culture tests showed that she was infected with E.coli. The patient was administered with imipenem/cilastatin 500 mg dissolved in 250 ml of sodium chloride 0.9% intravenously. Fifteen minutes later, the woman developed chill, palpitation, and dyspnea. The medication was withdrawn immediately. She was given oxygen therapy, physical hypothermy, and corticosteroids. Fortyfive minutes later, her symptoms were relieved, and two hours and a half later, her temperature was 38.4 ℃.
A 47yearold woman with urinary infection received oral moxifloxacin hydrochloride 400 mg. Two to three hours later, the woman developed nausea and hyperhidrosis, and 5~6 hours later, she developed visual hallucinations with seeing people and animals. The visions lasted for about 3 hours. The next day, the visual hallucinations reappeared 2 hours after repeated exposure to the same dose of moxifloxacin. Her EEG showed more rhythm with β fast wave. Moxifloxacin was discontinued, and she was given symptomatic therapy. The symptoms disappeared. At followup after half a year, there were no neurological symptoms and signs, and her EEG was basically normal.
A 56yearold man with hepatitis B and posthepatitic cirrhosis complicated by ascites was administered with 250 ml of glucose 5% mixed with adenosine triphosphate 40 mg and coenzyme A 100 U intravenously, and then furosemide 20 mg was added via Murphys dropper. Ten minutes later, the man developed pain over renal region. Abnormalities in urine routine and ultrasound B examinations were not found. His symptoms disappeared after receiving IM nefopam. The pain over renal region reappeared on repeated exposure to furosomide. Furosemide was discontinued and other drugs was continued, his symptoms disappeared.
A 65yearold man with hepatitis B was hospitalized with cirrhosis (decompensate period) and ascites. He was infused with hepatocyte growth promoting factors 80 mg dissolved in 100 ml of glucose 5％ intravenously. Two minutes later, the man developed cyanosis involving the face and lips, severe dyspnea, highpitched laryngeal stridor, and a three concave sign in inspiration. The infusion was discontinued, but other drugs were continued. The patient received corticosteroids and oxygen therapy. Twenty minutes later, his symptoms disappeared.
A 55yearold alcoholic man with pulmonary tuberculosis received oral isoniazide 0.3 g/d, rifapentine 0.45 g/d twice weekly, pyrazinamide 1.5 g/d. Three weeks later, the patient experienced hypodynamia, anorexia, dark urine, yellowish of skin and sclera, and ascites. Laboratory investigations revealed the following values: ALT 178.9 U/L, AST 85.7 U/L, TBiL 136.4 μmol/L, DBiL 134 μmol/L. Serologic tests for hepatitis A, B, C, D, and E were negative. The patient was given liverprotective and symptomatic treatment. Twelve days later, his symptoms improved and his liver function returned to normal ranges.
A 39yearold woman with onychomycosis took ketoconazole combined with griseofulvin for more than 2 months. Two months after discontinuation of the drugs, she developed severe yellowish in the skin and sclera. Liver function tests showed the following levels: ALT 564 U/L，AST 621 U/L，TBil 387 μmol/L. An ultrasound B examination revealed an increased liver echo intensity and a small amount of hydrops in abdominal cavity. She was diagnosed with severe subacute hepatitis. After admission, despite receiving liverprotective and symptomatic therapy as well as plasmapheresis, her liver damage progressively worsened. She died after discharge.
A 34yearold man with necrosis of femoral head was administered with oral Diedashenggu granules 10 g once daily. After two months, he developed nausea, aversion to fats, and abnormal liver function. Half a month after drug withdrawal, the liver function returned to normal limits. The medication was continued. Three months later, the patient presented with dark urine and hypodynamia. Laboratory investigations revealed the following values: ALT 1 008 U/L, TBil 633 μmol/L, DBil 482 μmol/L, Blood ammonia 96 μmol/L, PTA 43.1%. Color ultrasound examination showed rough liver echo, splenomegaly, and ascites. Diedashenggu granules was discontinued, and he was given liverprotective treatment. Two months later, his symptoms resolved gradually and his liver function normalised.
A 55yearold woman took 1 000 ml of senna infusion (1 ml was equivalent to senna 0.03 g) rapidly at night before colonoscopy. Two hours later, she developed frequent diarrhea. Six hours later, abnormal behavior, rave, and dysphoria occurred. Her blood sodium level was 120 mmol/L. Druginduced hyponatremia was suspected, and sodium chloride 3% was given intravenously. The next day, the patient regained normal consciousness and her blood sodium level return to normal limits.
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