2015 Volume 17 Issue 4 Published: 28 August 2015
  

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  • Analysis of medication instructions for elderly people in drug labels in China
    Lyu Guanbo, Liu Chen, Wang Yuqin
    2015, 17(4): 241.
    Abstract ( ) PDF ( )
    ObjectiveTo analyze the contents related to elderly people in medication instructions of oral drugs commonly used in China.MethodsOral medicines in Department of Outpatient Pharmacy, Xuanwu Hospital of Capital Medical University were recorded using Electronic Management System of drugs and composition ratio of different kinds of drugs were calculated. The notes for elderly people in medicine instructions were extracted and compared with administration suggestion (risk points) of the same drugs described in 2012 edition of Beers Criteria.ResultsA total of 368 kinds of oral drugs in Department of Outpatient Pharmacy were collected. Of them, varieties of drugs for central nervous system ranked first (93 kinds, 25.3%), varieties of drugs for cardiovascular system ranked second (62, 16.8%), varieties of drugs for digestive system ranked third (38, 10.3%)。Of the 368 kinds of oral drugs, medication instructions of 259 drugs (70.4%) were marked with notes for elderly people; medication instructions of 75 drugs (20.4%) were marked that no related tests were performed, no reliable references were provided or not clear; medication instructions of 34 drugs (9.2%) were not marked. Eighty kinds of drugs which were used in Department of Outpatient Pharmacy in 2013 were included in 2012 Beers Criteria. Of them, 8 kinds of drugs (10.0%) were not marked notes for elderly people and other 72 kinds of drugs (90.0%) were marked. Compared with the 2012 edition of Beers Criteria, the 72 kinds of drugs used in Department of Outpatient Pharmacy were divided into 4 kinds of results: risk points were not marked (52.5%，42/80), risk points were different (25.0%，20/80), risk points were less than those marked in Beers Criteria (6.3%，5/80), and risk points were identical (6.3%, 5/80). ConclusionThe notes for elderly people in medication instructions of commonly used oral drugs in China need further improvement to ensure medication safety in elderly patients.
  • Investigation on the method of essential medicines selection: angiotensin Ⅱreceptor antagonist drugs as templet
    Li Xiaoling, Yan Suying, Wang Yuqin, Zhao Chengcheng, Lu Lu
    2015, 17(4): 247.
    Abstract ( ) PDF ( )
    ObjectiveTo investigate the method of essential medicines selection in China. The angiotensin II receptor antagonist (ARB) drugs were taken as templet.MethodsARB drugs recommended by "Guidelines for the prevention and control of hypertension in China 2010" including losartan, valsartan, irbesartan, telmisartan, candesartan and olmesartan were included as the intended evaluating drugs. Each drug′s information (I), safety (S), administration restriction and frequency of drug administration (af), and efficacy (E) scores were evaluated respectively and were put together as ISafE. The weight and evaluation of every index were confirmed by the suggestions of specialists in clinical medicine, pharmacy, and epidemiology in China. The weight of safety and efficacy were 40%, respectively, and the information and administration restriction and frequency of drug administration were 10%, respectively. The score of each drug′s ISafE was calculated. The ratio of each drug′s daily medication costs to score of ISafE was the essential medicine cost index (EMCI).The EMCI of each drug was ranked according to the value. The  lower the drug′s EMCI value, the drug would be more likely to be recommended.Results The scores of information in the 6 ARB drugs from high to low in turn were losartan，valsartan, telmisartan, irbesartan, candesartan, and olmesartan. The scores of efficacy in the 6 ARB drugs from high to low in turn were olmesartan, telmisartan, valsartan, irbesartan, candesartan, and losartan. The scores of safety in the 6 ARB drugs from high to low in turn were telmisartan, olmesartan, irbesartan, candesartan, valsartan, and losartan. The 6 ARB drugs had the same scores in af value. The scores of ISafE in the 6 ARB drugs from high to low in turn were telmisartan, olmesartan, irbesartan, valsartan, losartan, and candesartan. The EMCI value of valsartan was the lowest among the domestic ARB drugs. The above-mentioned result was consistent with that of valsartan, which was the only ARB drug enrolled into the Chinese essential medicine list. The EMCI value of telmisartan was the lowest among the joint-stock ARB drugs.ConclusionISafE method, which has been optimized and localized, has the characteristics of objective information and high maneuverability and could provide reference for improvement of the selection of essential drugs in China.
  • Safety and efficacy of tenofovir disoproxil in treatment of women with chronic hepatitis B during pregnancy
    Fu Dong*, Liu Min, Yi Wei, Hu Yuhong, Cai Haodong
    2015, 17(4): 253.
    Abstract ( ) PDF ( )
    ObjectiveTo explore the safety and effectiveness of tenofovir disoproxil in patients with chronic hepatitis B during pregnancy.MethodsThe female patients with chronic hepatitis B in Beijing Ditan Hospital, Capital Medical University from January 1, 2011 to May 24, 2013, taking tenofovir disoproxil before pregnancy or during the first trimester of pregnancy (0-12 weeks of gestation) at least until delivery, were enrolled in the study. The efficacy of tenofovir disoproxil, adverse events during pregnancy and perinatal period, fetal growth and birth conditions, and the growth and development of newborns were observed. The active and passive immunization with hepatitis B vaccine 10 μg (0-1-6 regimen) and hepatitis B immune globulin (100-200 U) were administered to the newborns.ResultsForty-eight cases of pregnant women, of whom 3 cases (6.2%) had spontaneous abortion in early pregnancy; one case had spontaneous abortion and became pregnant again, were eligible for inclusion and 46 of the pregnant women were eventually enrolled into the study. Neither adverse events associated with tenofovir disoproxil nor abnormal laboratory test results and liver disease progression or DNA HBV rebound were found in any of the 46 pregnant women. The 46 pregnant women delivered 47 newborns, fetal tenofovir disoproxil exposure time was 31 to 41 weeks, in average (37.6+3.0) weeks, no fetal growth restriction or developmental delay were found in pregnancy monitoring. None of the 47 newborns had any abnormality at birth, and the results of screening for hearing, phenylketonuria and congenital hypothyroidism were all negative. The blocking of HBV mother-to-child transmission was successful. During the follow-up of 1-4 years after birth, except for 2 cases of hereditary diseases, no birth defects, organ damage or abnormal development associated with tenofovir disoproxil were found. Conclusion　Tenofovir disoproxil is relatively safe for the mother and fetus during pregnancy with chronic hepatitis B, and its antiviral effect is reliable.
  • Relationship between the uridine diphosphate-glucuronosyltransferase 1A1*6 polymorphisms and grade 3-4 neutropenia and diarrhea induced by irinotecan: a Meta-analysis
    Zhang Lingli, Peng Rui, Peng Yan
    2015, 17(4): 257.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the relationship between the uridine diphosphate-glucuronosyl-transferase 1A1 (UGT1A1)*6 polymorphisms and grade 3-4 neutropenia and diarrhea induced by irinotecan.MethodsThe databases of PubMed, Science Direct, Wiley Online Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database and VIP from the inception to January 15, 2015 were searched. The clinical research papers which were about the relationship between the UGT1A1*6 polymorphisms and grade 3-4 neutropenia and diarrhea induced by irinotecan were collected. The quality of methodology in enrolled papers were evaluated. The software Review Manager 5.3 was used for Meta-analysis. The evaluating indicators of the relationship between UGT1A1*6 and the adverse reactions of irinotecan were odds ratio (OR) and 95% confidence interval (CI).ResultsA total of 14 papers were enrolled into this Meta-analysis. The numbers of papers in Chinese and English were 5 and 9, respectively and all the papers were from Asian countries. The result of Begg test showed that there were no obvious publication bias in the enrolled papers. The results of Meta-analysis showed that compared with the patients who carried UGT1A1*1/*1 (wild type)，the risk of grade 3-4 neutropenia induced by irinotecan in the patients who carring UGT1A1*6/*6 (homozygous mutation) was significantly increased (OR=3.01，95%CI：2.01-4.50，P<0.000 01). Compared with the patients who carried UGT1A1*1/*1 (wild type)，the risk of grade 3-4 diarrhoea induced by irinotecan in the patients carring UGT1A1*6/*6 (homozygous mutation) and the patients carring UGT1A1*1/*6 (heterozygous mutation) were significantly increased (OR=3.79，95%CI：2.38-6.04，P<0.000 01；OR=1.68，95%CI：1.16-2.42，P=0.006). ConclusionsThe polymorphisms of UGT1A1*6 are associated with grade 3-4 neutropenia and diarrhea induced by irinotecan. The risk of grade 3-4 neutropenia due to irinotecan in the patient carring UGT1A1*6 homozygous mutation is increased. The risk of grade 3-4 diarrhoea induced by irinotecan in the patients carring UGT1A1*6 homozygous mutation and heterozygous mutation is increased.
  • The use of global trigger tool for evaluating adverse drug events in hospitalized patients
    Li Li, Liu Taotao, Jiang Xia
    2015, 17(4): 264.
    Abstract ( ) PDF ( )
    ObjectiveTo investigate the use of global trigger tool (GTT) for evaluating adverse drug events (ADE) in hospitalized patients.MethodsFourteen triggers were selected according to Institute for Healthcare Improvement Global Trigger Tool for Measuring Adverse Events and situation of medicine administration in China. Three hundred discharged patients′ medical records, coming from hospital information system of the First Affiliated Hospital of Guangxi Medical University from January to December 2013, were selected randomly and examined. The records with positive triggers were filtered and analyzed on estimation and classification of ADE as well as damage of organ and system. The detection rate of triggers was calculated and compared with the voluntary reporting rate of ADE in the same year.ResultsA total of 300 patients were involved in the 300 records. Of them, there were 59 patients with positive triggers accounting for 19.67％ and 72  cases with positive triggers including 48 patients with only one positive trigger, 9 patients with 2 positive triggers, and 2 patients with 3 positive triggers. The cases with positive triggers were analyzed on estimation of ADE. Sixty-four ADEs were confirmed and these ADEs involved 49 patients. The detection rate of ADE was 16.33% (49/300). The 64 ADEs contained 53  ADEs (82.81%) of level E, 6 ADEs (9.38%) of level F, and 5 ADEs (7.81%) of level H. The most common damage of organ was gastrointestinal system and a total of 21 cases developed gastrointestinal damages. The clinical manifestations were vomiting (20 cases) and diarrhea (1 case). The voluntary reporting rate of ADE in the same year was 0.43%(286/66 395), compared with the detection rate of triggers (16.33%), the difference was statistically significant (χ2=1 479.589，P<0.001).ConclusionCompared with the voluntary reporting rate, GTT could find more ADE.
  • Efficacy and safety of posaconazole in antifungal prophylaxis:a Meta-analysi
    Huang Jinzhu, Luo Xiao, Li Yong, Li Xin, Wang Ziqi, Tong Chunxiang, Zhao Zhenman, Lu Laichun
    2015, 17(4): 268.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the effectiveness and safety of posaconazole in antifungal prophylaxis.MethodsCNKI, VIP, CBM, Wangfang Database, PubMed, Cochrane Library, Embase, OVID, and Web of Science from the inception to March 2014 were searched. The randomized controlled trials (RCT) which compared posaconazole with placebo or other antifungal drugs in antifungal prophylaxis and the endpoint was the incidences of invasive fungal infection (IFI), all-cause mortality, or adverse reactions were collected. The related information was selected and RevMan 5.1 software of Cochrane Collaboration was used for statistical analysis. The results were expressed as odds ratios (OR) and its corresponding 95% confidence intervals (CI).ResultsA total of 6 RCTs were enrolled into the study. Of them, 4 RCTs were comparison of posaconazole with one other antifungal drug, and 2 RCTs were comparison of posaconazole with two kinds of other antifungal drugs. There were 1 410 cases in the experimental group and 929 cases in the control group. The results of Meta-analysis showed that the incidence of IFI in the experimental group was lower than that in the control group (OR=0.37, 95%CI: 0.27-0.50, P＜0.000 01). The results of comparison of posaconazole with other antifungal drugs showed that the incidence of invasive fungal infections in the experimental group were lower than those in the fluconazol group (OR=0.42, 95% CI: 0.28-0.64, P＜0.000 1) and the itraconazole group (OR=0.33, 95% CI: 0.21-0.53，P＜0.000 01). There were no statistical significant differences in incidence of invasive fungal infections between the experimental group and the control groups of voriconazole and amphotericin B (OR=0.13, 95% CI: 0.01-2.67, P=0.19; OR=0.11, 95% CI: 0.01-2.34, P=0.16). The incidence of invasive mold infection in the experimental group was lower than that in the fluconazole group (OR=0.25, 95% CI: 0.12-0.51, P=0.000 1) . There was no statistical significant difference in incidence of invasive mold infection between the experimental group and the itraconazole group (OR=0.10, 95% CI: 0.01-1.59, P=0.10). There were no statistical significant differences in incidence of invasive candida infection between the experimental group and the control groups of fluconazol and itraconazole (P=0.91, P=0.33). The all-cause mortality in the experimental group was lower than that in the control group (OR=0.64, 95% CI: 0.49-0.82, P=0.000 5). The incidence of adverse reactions in the experimental group was lower than that in the control group (OR=0.81, 95% CI: 0.66-0.99, P=0.04); but the result of subgroup analysis showed that there were no statistical significant difference in the incidence of adverse reactions between the experimental group and the control groups such as fluconazol, itraconazole, voriconazole, and amphotericin B liposomes (all P>0.05). It was considered that publication bias existed in above-mentioned 6 RCTs. ConclusionThe effectiveness of posaconazole in antifungal prophylaxis is better than those in the non-posaconazole drugs and the safety of posaconazole is similar to the non-posaconazole drugs.
  • Aspirin and the primary prevention of cardio and cerebrovascular diseases
    Du Haiyan, Lin Yang
    2015, 17(4): 275.
    Abstract ( ) PDF ( )
    Aspirin is an antiplatelet drug with the most abundant evidences of evidence-based medicine, which was used in the primary prevention of cardio and cerebrovascular diseases. It has been controversial on the benefits and the bleeding risks of aspirin for primary prevention of cardio and cerebrovascular diseases. In the present, the evidences mainly come from 9 large scale randomized controlled trials in the world and related Meta-analysis. In recent years, it is tended not to emphasize the role of aspirin for primary prevention in guidelines on cardio and cerebrovascular disease prevention in several countries. It is suggested in Chinese expert consensus on antiplatelet therapy published in 2013 that aspirin is given to the patients with medium and high risks who are decided according to the risks of cardio and cerebrovascular diseases.
  • Advances in peripheral neuropathy induced by chemotherapy and its prevention and treatment
    Guo Zihan, Jiao Yuanyuan, Zhao Bingqing, Zhang Yanhua
    2015, 17(4): 282.
    Abstract ( ) PDF ( )
    Peripheral neuropathy (CIPN) induced by chemotherapy is the common dose-limiting adverse reactions of platinum, taxol and vinblastine. The mechanisms of CIPN due to platinum, taxol and vinblastine may be related to injury of dorsal root ganglion, inhibition of tubulin depolymerization and changing axonal transport, inhibition of association of tubulin from protein subunit, deletion of tubulin and dysfunction of axonal transport, respectively. Pain, numbness, acanthesthesia, burning sensation, sensory deprivation, myodynamia weakness or paralysation, constipation, sexual dysfunction, change of vision, and anaudia are the main clinical manifestations of CIPN. Usually, the amplitude and the conduction velocity of sensory nerve action potential are decreased, while the amplitude and the conduction velocity of motor nerve are normal or slightly changed before the clinical symptoms of CIPN appearance. The development of CIPN are related with sex (female), age (agedness), habits and customs (smoking history), tumor type (oophoroma),  primary disease and combination with neurotoxic drug. The more the chemotherapeutics accumulated dose is, the higher the incidence of CIPN. The shorter the administration interval of chemotherapy is, the higher the incidence of CIPN. There is no effective drug for prevention of CIPN at present. Duloxetine is the the only one drug recommended by American Society of Clinical Oncology for treatment of CIPN.
  • dverse reactions of ritodrine hydrochloride in prevention of premature birth and the prophylactico-therapeutic measures
    Bao Chunrong, Yu Zicheng
    2015, 17(4): 287.
    Abstract ( ) PDF ( )
    Ritodrine hydrochloride, a beta 2 adrenergic receptor agonist, is used for prevention of preterm birth. Maternal cardiac arrhythmias, pulmonary edema, rhabdomyolysis, parotitis, granulocytopenia, acute generalized exanthematous pustulosis, nausea, vomiting, and elevated blood glucose are the main adverse reactions induced by ritodrine hydrochloride in the pregnant woman. The possible mechanisms of the above-mentioned adverse reactions may be associated with ritodrine hydrochloride inducing electrolyte imbalance, hypokalemia, changes of pulmonary capillary wedge pressure, muscular transient ischemia due to hypokalemia, hypersecretion of salivary amylase, bone marrow suppression, and promoting of glycogenolysis. The mechanism of acute generalized exanthematous pustulosis induced by ritodrine hydrochloride is yet unknown. Fetal over growth, fetal tachycardia, and neonates transient neutrophil reduction may be the main adverse reactions induced by ritodrine hydrochloride in the fetuses. The possible mechanisms may be associated with fetal insulin hypersecretion which is due to maternal hyperglycemia induced by ritodrine hydrochloride, immune-mediated toxic reactions through placental barrier, as well as changes in placental blood flow. The maternal heart rate, blood glucose, routine blood tests, liver and kidney function should be checked regularly when the pregnant woman is receiving ritodrine hydrochloride. Once the adverse reactions occured, ritodrine hydrochloride should be discontinued and the symptomatic treatment should be given. In infants whose mother received ritodrine hydrochloride, cardiac function should be evaluated by echocardiography when necessary,  blood glucose should be checked, and breast-feeding or formula feeding should be started as early as possible.
  • Oxaliplatin induced hepatic sinusoidal obstruction syndrome: prevention and treatment
    Yang Wanna, Hou Fengqin
    2015, 17(4): 291.
    Abstract ( ) PDF ( )

    Oxaliplatin is the third generation of platinum drugs, used in chemotherapy of colorectal carcinoma. Oxaliplatin can injure hepatic sinusoidal endothelial cells to induce hepatic sinusoidal obstruction syndrome (HSOS). The incidence of oxaliplatin induced HSOS was 77.4%. The clinical manifestations were hepatalgia, weight gain, ascites, hepatomegaly and jaundice. Histopathologic features include hepatic sinusoidal dilation and congestion, centrilobular vein obstruction, perisinusoidal fibrosis and centrilobular hepatic cell necrosis. The lack of typical imaging manifestations, biomarkers and effective treatment, so prevention-oriented strategy is important. Bevacizumab, regorafenib, sorafenib, recombinant human soluble thrombomodulin, and antioxidant may prevent HSOS. Defibrotide is recommended for treatment of HSOS.

  • Severe bronchial asthma induced by compound codeine phosphate and ibuprofen sustained release tablets
    Zhang Xiaolan, Zhao Peng, Ma Guoxian, Gao Jiayi
    2015, 17(4): 296.
    Abstract ( ) PDF ( )

    A 68-year-old female patient with multiple fractures of the right distal radius received oral compound codeine phosphate and ibuprofen sustained release tablets (containing ibuprofen 0.2 g, codeine phosphate 13 mg per tablet) 3 tablets twice daily  after plaster external fixation. Ten minutes after the first administration, the patient developed wheezing, palpitation, pale, cough, expectoration, nausea, and vomiting. Oxygen inhalation, IV infusion of doxofylline and methylprednisolone sodium succinate for injection, and terbutaline sulphate solution for nebulization and budesonide suspension for inhalation were given immediately. Two hours after treatments, wheezing was relieved and wheezing rales in the lung disappeared. By asking the medical history, it was found that the patient had developed wheezing after taking somedon and was diagnosed as bronchial asthma 1 month ago in another hospital.

  • Autoimmune progesterone dermatitis induced by dydrogesterone
    Kong Fang, Zhao Yi, Liao Qiuju, Su Li, Huang Xu, Yu Naichang, Li Xiaoxia
    2015, 17(4): 297.
    Abstract ( ) PDF ( )
    A 41-year-old woman with systemic lupus erythematosus (SLE) took 10 mg dydrogesterone orally twice daily for 7 days for endometrial hyperplasia．Four days after dydrogesterone administration, she developed red maculopapule on her face. She took dydrogesterone at the same dosage for 14 days for second month and developed more severe rashes and generalized exanthematous pustulosis. Active SLE, infections, intoxication or tumors were excluded by lab examinations and SLE disease activity index scores and autoimmune progesterone dermatitis induced by dydrogesterone was diagnosed. Dydrogesterone was stopped and antianaphylaxis treatment was given. Two months later, her symptoms improved gradually and no skin rash was found at 3-month follow-up.
  • Epilepsy induced by procaine benzylpenicillin in children: report of 2 cases
    Yang Ling
    2015, 17(4): 299.
    Abstract ( ) PDF ( )
    Two male children (aged 11 and 7 years, respectively) received intramuscular injections of procaine benzylpenicillin 650 000 U and 600 000 U twice daily for streptococcal infection syndrome and acute tonsillitis, respectively. Convulsions, unconsciousness, facial cyanosis, upward deviation of the eyes appeared after the tenth and the third intramuscular injections, respectively. Intramuscular injections of dexamethasone 5 mg and oxygen inhalation through nasal tube were given immediately and the symptoms were improved within 1 min. No positive signs were found on the physical examinations and no abnormal findings were detected by brain CT, EEG and blood biochemical tests. Both patients recovered after treatment with other antimicrobial drugs and the convulsion did not occur at 1 year of follow-up.
  • Severe liver injury and thrombocytopenia induced by edaravone
    hen Yanfang, Feng Xia, Wang Ruolun
    2015, 17(4): 300.
    Abstract ( ) PDF ( )
    A 47-year-old man received an IV infusion of edaravone 30 mg twice daily for acute cerebral infarction. Three days later, the patient developed yellowish sclera. Laboratory examination showed the following levels: aspartate aminotransferase (AST) 269 U/L, alanine aminotransferase (ALT) 1 944 U/L, γ-glutamyl transpeptidase (γ-GT) 133 U/L, total bilirubin (TBil) 100.01 μmol/L, and platelet count 70×109/L. The patient was diagnosed as severe liver injury and thrombocytopenia due to edaravone injection. Edaravone was stopped and an IV infusion of polyene phosphatidylcholine 465 mg once daily was given. Seven days later, the patient′s yellowish sclera disappeared. Laboratory examination showed AST 44 U/L, ALT 187 U/L, γ-GT 148 U/L, TBil 25.4 μmol/L, and platelet count 121×109/L. Twelve days later, reexaminations showed AST 39 U/L, ALT 77 U/L, and γ-GT 126 U/L.
  • Acute hyperlipidemic pancreatitis due to estradiol valerate/cyproterone acetate
    Su Jun, Zhang Ying, Hu Wei
    2015, 17(4): 302.
    Abstract ( ) PDF ( )
    A 43-year-old woman received hormone replacement therapy because of menopause. She took 1 tablets of estradiol valerate/cyproterone acetate a day orally for 21 days continually and had an interval for 7 days, she repeated the cycle continuously. Her serum triglyceride (TG) was 1.55 mmol/L before the drug administration and increased to 3.25 mmol/L 18 months after the beginning of the treatment which was  the result of a laboratory examination performed before blood donation. She took dietary control only. She developed abdominal pain, abdominal distention, nausea and vomiting after eating greasy food 24 months after the treatment started. She was hospitalized the next day. Laboratory examination revealed that TG was 23.00 mmol/L, amylase 892 U/L, lipase 560 U/L, urine amylase 1 020 U/L. Abdominal ultrasound examination showed diffuse enlargement of pancreas and obvious peripancreatic exudation. The patient was diagnosed as acute hyperlipidemic pancreatitis. Estradiol valerate/estradiol cyproterone was stopped. She received the symptomatic treatments, including fasting, gastrointestinal decompression, plasmapheresis, anti-inflammatory drugs, acid suppression, enzyme inhibition, and fluid resuscitation. The patient received plasmapheresis for 6 times totally. Her serum TG levels were 18.50, 15.00, 11.70, 9.20, 5.20 and 2.20 mmol/L, respectively. Twenty days later, all the symptoms of the patient disappeared completely and the patient was discharged.
  • Late-onset drug fever due to piperacillin/tazobactam
    Lin Lu*, Chen Wenying, Hong Xiaofeng, Zhang Xiaojuan, Yang Min
    2015, 17(4): 304.
    Abstract ( ) PDF ( )
    A 43-year-old man with type 2 diabetes was treated with an intravenous (IV) infusion of piperacillin-tazobactam (4.5 g dissolved in 0.9% sodium chloride for injection 100 ml, every 8 hours) for diabetic foot gangrene. There were pain, ulceration and purulent secretions on his right foot back before treatment. His body temperature was 36.8 ℃. Laboratory test before the treatment showed the following values: white blood cell count (WBC) 11.5×109/L, neutrophil 0.73, eosinophils 0.02, C-reactive protein (CRP) 104.0 mg/L. On day 4 of treatment, the symptom of his foot was alleviated, the purulent secretion from foot was reduced. Laboratory test showed that  WBC was 9.4×109/L, neutrophil 0.61, eosinophils 0.03. On day 12 of treatment, laboratory test showed that WBC was 6.1×109/L, neutrophil 0.60, eosinophils 0.04. On day 14 of treatment, the patient had high fever (41.2 ℃), laboratory test showed the following values: WBC 3.4×109/L, neutrophil 0.58, eosinophils 0.11, CRP 11.3 mg/L, erythrocyte sedimentation rate 86 mm/1 h, procalcitonin 0.08 μg/L. The patient was diagnosed as late-onset drug fever due to piperacillin-tazobactam. On day 15, piperacillin-tazobactam was stopped. Forty-eight hours after drug withdrawal, his body temperature decreased to 36.8 ℃. The results of reexamination of routine blood test showed almost normalized values: WBC 9.8×109/L, neutrophil 0.70, eosinophils 0.04.
  • Bilateral median nerve injuries after chemotherapy with paclitaxel and carboplatin
    Yang Shuiyuan, Wu Hong, Zeng Siyu, Tong Yanli, Mei Qinghua
    2015, 17(4): 306.
    Abstract ( ) PDF ( )
    A 50-year-old female patient with serious borderline tumor received chemotherapy with paclitaxel and carboplatin (an IV infusion of paclitaxel 198 mg and  carboplatin 395 mg on the first day of treatment, the cycle of treatment was 21 d) after undergoing total hysterectomy, bilateral ovarian, and greater omentum resection. After the IV infusion of third chemotherapy cycle, the patient developed persistent and progressive numbness and pain of fingers which could radiate to the elbow. After treatment with carbamazepine and mecobalamin, the symptoms were not relieved. Thus it was considered that the adverse reactions may be caused by chemotherapy drugs. So the chemotherapy was paused temporarily, and prednisone, rebamipide, mouse nerve growth factor for injection,  and mecobalamin were given. After 14 d of treatments, the patient′s symptoms were alleviated apparently. At half a year of follow-up, the patient developed slight atrophy in the right thenar muscle and hypoesthesia in bilateral index finger and middle finger palm.
  • Allergy complicated with abdominal pain and colporrhagia due to oral moxifloxacin
    Yao Danlin, Mu Hongmei
    2015, 17(4): 307.
    Abstract ( ) PDF ( )
    A 45 year-old woman with acute bronchitis  took moxifloxacin 0.4 g orally by herself. She  developed pruritus and rubefaction on the whole body, edema in the face, hoarseness, vomiting, abdominal pain, and diarrhea 5 minutes after taking the medicine. About 25 minutes later, she developed clouded vision and became unconscious. She was given an intravenous injection of methylprednisolone 120 mg, and rapid intravenous drip of 0.9% sodium chloride injection 1 000 ml. But the abdominal pain did not alleviate. She developed colporrhagia one hour after taking the medicine. The result of abdominal ultrasound examination showed no obvious abnormity. Then she was given an intramuscular injection of meperidine 100 mg. About 30 minutes later, her abdominal pain was relieved. Twenty-four hours after receiving moxifloxacin, her colporrhagia was stopped. The patient had a similar experience of morbidity, diagnosis and therapy one month ago.
  • Postoperative delirium and blurry vision in children associated with penehyclidine and scopolamine
    Wang Jianshe, Fei Jian, Zhang Xifeng
    2015, 17(4): 309.
    Abstract ( ) PDF ( )
    An 8-year-old girl was scheduled to undergo appendectomy for acute appendicitis. Preoperative conditions were normal. Scopolamine 0.2 mg was intramuscularly injected 30 min preopera-tively. Anesthesia was induced by penehyclidine hydrochloride(0.3 mg), midazolam (1.0 mg), fentanyl (80 μg), propofol (80 mg) and rocuronium (25 mg), and propofol (6-8 mg·kg-1·h-1) and remifentanil (0.2-0.5 μg·kg-1·min-1) for maintenance. Surgery went smoothly and safely.After three hours,the patient complained of blurred vision, and delirium. Bilateral pupils enlarged as compared with that of normal age, light reflex was normal.Ophthalmological consultation considered it as anticholinergic drug-induced mydriasis, with no special treatment. About 15 h postoperatively delirium disappeared and about 50 h postoperative blurred vision disappeared.
  • Severe intestinal perforation due to bevacizumab
    Xu Jingpu, Kong Wei, Dai Wenting, Zheng Liya, Fu Changfang
    2015, 17(4): 310.
    Abstract ( ) PDF ( )
    A 65-year-old female patient was given treatment scheme of bevacizumab (0.386 g, the first day), oxaliplatin (150 mg, the first day) and capecitabine (1 g, twice daily, the first day to the 14th day) for colon cancer with liver metastasis. Twenty-three days after administration, the patient developed upper abdominal pain. She was diagnosed of gastrointestinal perforation and diffuse peritonitis by abdominal X-ray and CT scan. Emergency exploratory laparotomy was performed and a perforation with a size about 5 cm×2 cm was found at the location of ascending colon 5 cm away from ileocecus. Then an ascending colon and terminal ileum fistula operation was performed. After the patient's condition was stable, she was given oxaliplatin and capecitabine to continue treatment.
  • Elevated serum urea and amylase following tigecycline
    Hao Yugui, Yi Fanfan, Cheng Wenwei
    2015, 17(4): 312.
    Abstract ( ) PDF ( )
    A 73-year-old woman with chronic bronchitis, pulmonary interstitial fibrosis, bronchiectasis concurrent infection received an IV infusion of levofloxacin 0.4 g once daily. One week later, her symptoms were not improved. An IV infusion of tigecycline 50 mg twice daily was added to her regimen according to sputum culture results and drug sensitivity test. Nine days later, the patient developed nausea and vomiting. Laboratory tests showed serum urea value of 36.5 mmol/L and amylase 1 166 U/L. Tigecycline was replaced by IV infusion of imipenem and cilastatin sodium 1.0 g thrice daily, and levofloxacin continued. Octreotide acetate and pantoprazole sodium were given. Fasting and fluid supplement were applied. One week later, the nausea and vomiting disappeared. Her serum urea and amylase were 8.1 mmol/L and 42 U/L, respectively.
  • Hypomagnesemia induced by cetuximab
    Fang Wentong, Luo Can
    2015, 17(4): 313.
    Abstract ( ) PDF ( )
    A 62-year-old male patient received an IV infusion of cetuximab (cycle 1: 716 mg, cycle 2-34: 447.5 mg) once weekly since July 19th, 2012 for postoperative anastomotic recurrence of rectal cancer and liver metastasis. Blood magnesium was 0.35 mmol/L and other electrolyte levels, biochemical indexes, aldosterone level, thyroid function tests, blood routine, urine routine and stool routine tests were normal when he was admitted to hospital on March 28, 2013. Review patients′ medical records, blood magnesium level was gradually reduced and accompanied with the application of cetuximab, blood magnesium was 0.51 mmol/L on January 31, 2013. It was considered that the cetuximab induced hypomagnesemia. An intravenous infusion of magnesium sulfate 10 ml plus 0.9% sodium chloride 500 ml once daily was given. On day 3, the blood magnesium was 0.54 mmol/L, and cetuximab 447.5 mg was given, he was discharged. Magnesium sulfate was given in outpatient clinic. Eight days later, his blood magnesium was 0.82 mmol/L.
  • Paiduyangyan capsule(排毒养颜胶囊) induced autoimmune hepatitis-like liver injury
    Wang Tailing, Wang Guiqiang
    2015, 17(4): 315.
    Abstract ( ) PDF ( )
    A 36-year-old woman developed fatigue, anorexia, and yellowish skin after taking Paiduyangyan capsule by herself for a month. Liver function tests showed the following results: alanine aminotransferase (ALT) 1 032 U/L, aspartate aminotransferase (AST) 602 U/L, total bilirubin (TBil) 61.7 μmol/L, direct bilirubin (DBil) 45 μmol/L,  γ-glutamyl transferase (γ-GT) 148 U/L, alkaline phosphatase (ALP) 140 U/L. Paidugangyan capsule was stopped and liver-protective treatments were given but there were no marked treatment effects. The levels of above mentioned parameters increased continuously and anti nuclear antibody (ANA) level increased one month after the onset of the liver injury. The highest titer of ANA was >1 ∶  1　000. Liver biopsy result suggested that the liver injury was caused by drugs. Four and a half months after the onset of liver injury, the patient received prednisolone (initial dose was 60 mg once daily and then the dose was gradually reduced). After 3 months of prednisolone treatment, the patient′s liver function parameters returned to normal. After 7 months of prednisolone treatment, the patient′s ANA level returned to normal and all symptoms disappeared. After 7 and a half months of treatment, prednisolone was stopped. The symptoms did not recur at 7 years of follow-up.
  • Digoxin excessiving resulted atrial fibrillation with Ⅲ degree atrioventricular block
    Li Yi, Yin Fenghua, Lai Bei
    2015, 17(4): 318.
    Abstract ( ) PDF ( )
    A 72-years-old woman mistook digoxin 40 tablets (10 mg) within 7 days for chronic cardiac insufficiency. She developed nausea, vomiting, blurred vision, xanthopsia, chloropsia and dizziness. After admission, her heart rate was 38 beats/min and blood pressure was 135/75 mmHg. Electrocardiogram revealed atrial fibrillation with 3rd degree atrioventricular block. Digitalis poisoning was diagnosed. She was given oral theophylline 200 mg, intramuscular injection of 10 mg anisodamine. After 2.5 hours, the heart rate did not significantly change. She was given intramuscular injection of atropine 0.5 mg, intravenous infusion of atropine 0.5 mg and 1.0 mg once every 0.5 hour. Her heart rate continued to decline, the lowest heart rate was 19 beats/min, and developed unconsciousness and hallucination. She received isoprenaline 1 mg by a continuous infusion pump delivering 0.5 μg per minute. The heart rate was maintained at about 40 beats/min. On day 2, the patient regained consciousness. Electrocardiogram showed atrial fibrillation with ventricular bigeminy. Isoprenaline was stopped and ventricular bigeminy disappeared. Her heart rate was 38 times/min. On day 5, the blurred vision, xanthopsia and chloropsia disappeared. On day 6, the nausea and vomiting disappeared. On day 8, the electrocardiogram revealed atrial fibrillation with a heart rate of 54 beats/min.
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