2015 Volume 17 Issue 5 Published: 28 October 2015
  

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  • Zhang Yan, Su Yingying, Ye Hong, Gao Daiquan
    2015, 17(5): 321.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the efficacy and safety of intravenous immunoglobulin (IVIG) for treatment of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis.MethodsData of patients with anti-NMDA receptor encephalitis seen in Xuanwu Hospital, Capital Medical University from January 2012 to December 2014 were collected and a retrospective study was conducted. All patients received the first course of treatment with IVIG 0.4 g/(kg·d), once daily for 5 consecutive days. The adverse reactions of IVIG during the observational period of IVIG administration and one week thereafter were recorded. The therapeutic effect of IVIG was assessed by using modified Rankin Scale one month post IVIG. According to the therapeutic effect of IVIG, patients were divided into effective group and ineffective group.ResultsTwenty-six patients were enrolled, including 11 male and 15 female with an average age of (25±10) years (16 to 57 years). The duration from symptom onset to starting treatment of IVIG was 8-68 days (median 26 days). Treatment effects were assessed after one month post IVIG. Fourteen patients (53.8%) had improvement (effective group, including 6 patients who were improved significantly and 8 patients improved). The mean duration between the treatment of IVIG and clinical improvements was 17 (range 7-30) days. Percentage of male in the effective group was higher than that in the ineffective group [64.3% (9/14) vs.16.7% (2/12), P<0.05]. The efficacy rate in males patients was higher than that in female patients[81.8% (9/11) vs. 33.3% (5/15), P<0.05]. During the observational period, 3 patients had fever, 2 patients had abnormality of liver function, and 1 patient had rash. The symptoms and abnormality of laboratory tests disappeared after reducing the speed of IVIG infusion, liver-protective and antianaphylactic treatment. ConclusionThe treatment with IVIG for anti-NMDA receptor encephalitis was effective and relatively safe, therefore IVIG could be used as the first-line immunotherapy.
  • Liao Yin, Cheng Sheng, Luo Xiao, Wen Aiping, Zhang Yang, Shi Limin
    2015, 17(5): 325.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the effectiveness and safety of immunosuppressive program including tacrolimus (FK506) in infants after liver transplantation.MethodsThe medical records of infants who underwent liver transplantation for biliary atresia and receiving the immunosuppressant of FK506 combined with methylprednisolone (MP) after operation in Beijing Friendship Hospital during June 2013 to September 2014 were collected. The infants′ general clinical situation, recipient survival rate, survival rate of transplanted liver, transplant complication, acute rejection rate, and adverse reactions were recorded. The whole blood trough concentration of KF506 on day 3, 7, 15 and one month after medication and occurrence of rejection and adverse reactions were recorded.ResultsA total of 54 infants were enrolled into this study, 50% were boys.  The children′s age was 4-19 months, the median age was 8 months. Seven infants died within 14 to 45 days after liver transplantation. Both recipient survival rate and survival rate of transplanted liver were 87%. Three cases (5.6%) developed transplant complication on days 7-9 after operation, among them 2 cases had hepatic artery thrombosis and 1 case had bile leakage, respectively. Ten infants (18.5%) developed acute rejection on days 4-14 after operation. The incidence of adverse reaction during hospitalization was 35.2% (19/54).  Twenty-five case-times adverse reactions involved 19 infants. There were 5 case-times of severe adverse reactions which involved 5 infants (3 cases died from epilepsia, increased creatinine, and heart failure, respectively; 2 cases recovered to normal from increased serum alanine aminotransferase after the treatment of liver protection). There were 20 case-times general adverse reactions (diarrhea, vomiting and skin rash etc.) which involved 17 infants. They all improved after symptomatic treatment. The mean blood concentration of FK506 on days 3, 7, 15 and one month after medication were (9.6±5.7), (8.7±4.5), (9.2±3.7) and (8.6±4.1) μg/L, respectively. The blood concentration of FK506 was 2.4-9.3 μg/L with an average concentration of (5.10±2.04)μg/L when acute rejection occurred and 6.2-23.9 μg/L with an average concentration of (11.67±3.58) μg/L when adverse reactions occurred. The average blood concentration of FK506 was(11.67±3.58)μg/L and the concentrations in 17 of 25 cases were over 10 μg/L. ConclusionFK506 at blood concentration 6.0-11.0 μg/L in infants used for immunosuppressive therapy after liver transplantation is relatively effective and safe.
  • Sun Limei, Su Haitao, Wang Hairong
    2015, 17(5): 330.
    Abstract ( ) PDF ( )
    ObjectiveTo find out the therapeutic scheme which was effective and made less injury for liver in patients with pulmonary tuberculosis complicated with hepatitis B.MethodsThe clinical data of patients with pulmonary tuberculosis and hepatitis B who received combination therapy of 3HLVE/6HLE (H: isoniazid; L: rifapentine; V: levofloxacin; E: ethambutol) or 3HRZE/6HRE (R: rifampicin; Z: pyrazinamide) in Qingdao Chest Hospital from January, 2010 to December, 2013 were collected and analyzed retrospectively. The patients were divided into the observation group and the control group. The patients in the observation group received combination therapy of 3HLVE/6HLE (H, L, V, and E were given for 3 months as the intensifying period and then H, L, and E for 6 months as a consolidation period), while the patients in the control group received combination therapy of 3HRZE/6HRE (H, R, Z, and E were given for 3 months as the intensifying period and then H, R, and E for 6 months as the consolidation period). The patients in the 2 groups received silibinin capsules at the same time. The patients′serum alanine aminotransferase (ALT) levels, serum total bilirubin (TBil) levels, the sputum bacterial negative conversion rate, and the efficiency of lesion absorption after 3 or 6 months of treatments were recorded and the incidence of liver injury and efficacy of anti-tuberculosis scheme between the 2 groups were compared.ResultsA total of 102 patients in accordance with the inclusion criteria were collected. Of them, 50 cases were in the observation group and 52 cases in the control group. There were no statistically significant differences in patients′age, gender distribution and tuberculosis lesions between the 2 groups (P>0.05). The incidence of liver injury in the observation group (26.0%, 13/50) was lower than that in the control group (46.2%, 24/52) (P<0.05); the degree of liver injury in the observation group[ALT:(81.6±8.5)U/L vs.(92.0±14.7)U/L; TBil :(22.5±10.2)μmol/L vs.(36.8±14.5)μmol/L]was lower than that in the control group (P<0.05); the time to liver function normal-ization in the observation group (15.4±3.1 d) was shorter than that in the control group (18.2±3.9 d) (P<0.05). After 3 months of treatment, the sputum bacterial negative conversion rate in the observation group (85.4%, 35/41) was higher than that in the control group (64.1%, 25/39) (P<0.05). After 6 months of treatment, the difference of the sputum bacterial negative conversion rate between the 2 groups was not statistically significant (P>0.05). After 3 or 6 months of treatment, the differences of the efficiency of lesion absorption between the 2 groups was not statistically significant (P>0.05). ConclusionAnti-tuberculosis scheme of 3HLVE/6HLE was a better therapeutic scheme in the early stage in patients with pulmonary tuberculosis and hepatitis B, which was more effective and made less liver injury.
  • 2015, 17(5): 334.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the risk of infection in monotherapy of tumor necrosis factor alpha (TNF-α) inhibitor.MethodsThe database of Pubed, Embase, Cochrane library, and Web with Science were searched from the inception to November, 2014. The literatures of randomized controlled trials in English which included reports that only used TNF-α inhibitor (the test group) and placebo or positive controlled drug (the control group)were selected. The methodological quality of the literatures which enrolled into the study were assessed by Jadad scale (inferior quality: <3 points, high quality: 3-5 points). The software RevMan 5.2 was used for Meta-analysis. The infection rate and the severe infection rate were expressed by relative risk (RR), Peto odds ratio (Peto OR)and 95% confidence interval (CI).ResultsA total of 33 trials presented by 32 reports, and 11 819 patients (7 408 cases in the test group using adalimumab or golimumab or infliximab or etanercept, respectively, and 4 411 cases in the control group using placebo, positive control drug such as methotrexate or salazosulfapyridine, respectively )were enrolled into the Meta-analysis. The Jadad scores of the 33 trials were all≥3 points. The results of the Meta-analysis showed that the overall total incidence of infection in patients who used TNF-α inhibitors only was higher than that in the patients who used placebo [33.03% (1 702/5 153) vs.29.53%(873/2 956), RR=1.17, 95%CI: 1.09-1.25, P<0.000 01]. There was no significant difference in the overall incidence of infection between the test group and the positive controlled drug group [50.1% (362/723)vs.48.3%(320/662), RR=1.10, 95%CI: 0.90-1.34, P=0.36]. There were no significant differences in the incidence of severe infection between the test group and the placebo control group, the positive controlled drug group [1.4% (73/5 067)vs.1.7% (48/2 902), Peto OR=0.90, 95%CI: 0.61-1.32, P=0.46; 2.4% (34/1 410) vs.2.8% (28/976), RR=1.10, 95%CI: 0.90-1.34, P=0.36]. The results of subgroup analysis showed that the incidence of infection in patients who used adalimumab, or golimumab or infliximab only were significantly higher than that in the patient who used placebo [41.4% (568/1 373) vs.39.1% (361/923), RR =1.11, 95% CI: 1.01-1.23, P=0.04; 25.5% (397/1 558) vs.19.2% (120/625), RR: 1.22, 95%CI: 1.02-1.45, P=0.03; 38.2% (297/777) vs.27.7% (114/411), RR=1.35, 95%CI: 1.13-1.61, P=0.001]. There was no significant difference in the incidence of infection between the patients who used etanercept and the patients who used placebo [30.4% (440/1 445) vs.27.9% (278/997), RR=1.13, 95%CI: 0.99-1.28, P=0.06]. The incidence of severe infection in patients who used golimumab was significantly lower than that in the patient who used placebo [0.59% (8/1 355) vs.2.12% (11/520), Peto OR=0.21, 95%CI: 0.08-0.59, P=0.003]. There were no significant differences in the incidence of severe infection between the patients who used the other 3 kinds of drugs and the patients who used  placebo (all P>0.05).ConclusionsThe monotherapy with TNF-α inhibitor may increase the overall incidence of infection, but will not increase the incidence of severe infection. The monotherapy with TNF-α inhibitor is relatively safety in clinical practice.
  • Li Xingang, Zhao Kun, Lu Yanxia, Zhao Zhigang, Liu Zhenhua
    2015, 17(5): 343.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the correlation between paraoxonase 1 (PON1) Q192R polymorphism and cardiovascular adverse events in patients treated with clopidogrel.MethodsWeb of Knowledge, PubMed, ScienceDirect, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and CQVIP were searched from the inception to March 2015 and prospective cohort studies in accordance with the criteria were collected. Meta-analysis was performed using RevMan 5.3 software and the results were represented as odd ratio (OR) and 95% confidence interval (CI).ResultsA total of 12 studies and 10 090 patients were included in this Meta-analysis. Of them, 2 113 patients were Asian, 7 396 were European, and 581 were North American; 4 096 patients had QQ genotypes and 5 994 QR+RR genotypes. All studies were high quality. The incidence of cardiovascular adverse events in patients with PON1 192QQ genotypes in Asian group was 8.1% (38/472) and 10.8% (177/1 641) in patients with QR+RR genotypes (OR=1.06, 95%CI: 0.64-1.75, P=0.82). The incidence of adverse events in patients with PON1 192QQ genotypes in North American group was 10.4% (27/260) and 10.9% (35/321) in patients with QR+RR genotypes (OR=0.95, 95%CI: 0.56-1.63, P=0.42). The incidence of adverse events in patients with PON1 192QQ genotypes in European group was 6.5% (217/3 364) and 5.6% (225/4 032) in patients with QR+RR genotypes (OR=1.21, 95%CI: 0.85-1.73, P=0.28). After integrating the 3 subgroups, the incidence of cardiovascular adverse events in patients with PON1 192QQ genotypes was 6.9% (282/4 096) and 7.3% (437/5 994) in patients with QR+RR genotypes (OR=1.13, 95%CI: 0.89-1.44, P=0.33). No statistically significant publication bias or selective bias was found from funnel plot. ConclusionThere were no correlation between the PON1Q192R polymorphism and the cardiovascular adverse events in patients treated with clopidogrel.
  • Geng Kuikui, Wu Shuhua, Liu Sheng, Shen Aizong, Hou Huan, Li Yuanya
    2015, 17(5): 348.
    Abstract ( ) PDF ( )
    ObjectiveTo construct the active monitoring system for adverse drug reactions based on the trigger technology and explore its application value.MethodsBased on the DTHealth system and electronic medical records system, using the Brower/Server architecture, DHCMedBase2.0.doc, Ext 3.1-API Documentation technology to design the trigger of the data definition language. The monitoring group selected the adverse drug reactions which can be used to reflect with the laboratory information, 12 triggers were chosen after communicating with the clinical medical staff, the related procedures were embedded in the hospital information system, accordingly, the active monitoring system of adverse drug reaction based on the trigger technology were constructed. By the three pharmacists the full-time work, the monitoring work within 23 wards of the hospital about 800 patients were finished through the triggers of adverse drug reactions monitor, and the suspected adverse drug reactions were filtered, evaluated and reported.ResultsThe active monitoring system of adverse drug reactions based on the trigger technology started operation in January 1st, 2014, and run until the June 30th, 2014, 561 positive patients were monitored by the triggers, and 71 adverse drug reactions which involved 28 kinds of drugs were identified, the total positive rate was 12.7%. The laboratory index of 21 patients were found to have a marked abnormality but not beyond the normal range, among them the 12 patients had to change the treatment to avoid the possible adverse drug reactions. ConclusionThe application of the trigger technology successfully constructed the active monitoring system of adverse drug reactions, which can improve efficiency of the active monitoring for adverse drug reactions, at the same time, realize the early warning function.
  • Wang Haizheng, Lin Xiaolan, Zhang Peng, Wang Yawei, Chen Wenqiang
    2015, 17(5): 353.
    Abstract ( ) PDF ( )
    ObjectiveTo understand the characteristics of medication errors (ME) of traditional Chinese medicine in elderly patientsMethodsME reports of traditional Chinese medicine in elderly patients which were collected from International Network for the Rational Use of Drugs (INRUD) from January 1st, 2013 to November 31st, 2014 were selected and analyzed. The major types of ME, persons who triggered the ME, triggering factor, category, and persons who detected the ME were analyzed descriptively.ResultsA total of 520 ME reports were collected from 23 hospitals. The number of ME on medication usage and dosage in ME types ranked first and accounted for 48.5% (252/520), the number of deployment errors ranked second and accounted for 19.8% (103/520). In terms of the persons  triggering the ME, the percentage of physicians and pharmacists were 70.0% (333/476) and 29.4% (140/476), respectively. Triggering factors of ME were lack of knowledge of traditional Chinese medicine [30.0% (114/380)] and similar names of different drugs [16.3% (62/380)]. Intermediate and primary titles of pharmacists in persons who detected ME accounted for 53.2% (271/509) and 37.5% (191/509), respectively. The ME belonging to category A, B, and C accounted for 16.0% (83/520), 68.5% (356/520), and 13.8% (72/520)], respectively and all these errors did not do harm to patients. The errors belonging to category D and E accounted for 1.5% (8/520) and 0.2% (1/520), respectively. ConclusionsIn elderly patients, the errors in usage and dosage of traditional Chinese medicine were main types of errors and most of the ME were mild and did not do harm to patients. The triggering factor of the ME were lack of knowledge of traditional Chinese medicines in physicians and pharmacists.
  • Zhang Ailing, Qin Guijun, Meng Haiyang, Liu Yanxia, Zhang Xiaojian
    2015, 17(5): 357.
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    Drug-induced gynecomastia with the benign enlargement of male breast glandular tissue was reported to cause an imbalance between estrogen and androgen action then lead to an increased estrogen to androgen ratio by drugs. Drugs are estimated to cause about 10%~25% of all cases of gynecomastia. Some commonly used drugs, such as spironolactone, ketoconazole, imatinib, bicalutamide, finasteride, cimetidine can cause gynecomastia. Clinical manifestations of drug-induced gynecomastia cause breast pain, tenderness or galactorrhea. Estradiol and estriol increased, while luteinizing hormone (LH), follicle stimulating hormone (FSH), and testosterone decreased in the laboratory tests. In the patients with drug-induced gynecomastia the causative medications should be withdrawn; if gynecomastia persists, the patients can be treated with tamoxifen. Surgery can be performed if treatment with tamoxifen was not effective or the clinical manifestations persist for one year.
  • Li Na
    2015, 17(5): 361.
    Abstract ( ) PDF ( )
    Sunitinib is one of the targeting multiple receptor tyrosine kinase inhibitors. Sunitinib is used to treat advanced renal cell carcinoma, and refractory gastrointestinal stromal tumor patients with which are intolerant or resistant to imatinib. The common adverse reactions of sunitinib include fatigue and weakness, mucocutaneous adverse reactions (hand foot skin reaction, changing in skin color, hair depigmentation, splinter hemorrhages, stomatitis, and lipsotrichia), adverse reactions in cardiovascular system (hypertension, left ventricular ejection fraction decrease with or without symptoms, heart failure), and hypothyroidism etc. The mechanism of fatigue and weakness may be related to the inhibition of adenosine monophosphate-activated protein kinase, inducing hypoxia, influence of glucose transport, and decreased capability of glucose uptake. The mechanism of adverse reactions in mucocutaneous tissues may be related to the inhibition of vascular endothelial growth factor and platelet-derived growth factor, blocking the activation of melanocyte microphthalmia associated transcription factor, inhibition of signal transduction and activators of transcription 3, promoting the expression of Fas/Fas L, and inducing the mitochondrial injury. The mechanism of adverse reactions in cardiovascular system may be related to the off-target effects to heart platelet-derived growth factor receptor and the inhibition of heart angiogenesis, the inhibition of ribosomal protein S6 kinase and AMP dependent protein kinase, inducing the mitochondrial injury, and he inhibition of nitric oxide production. The mechanism of hypothyroidism due to sunitinib may be related to the decrease of  the blood supply of thyroid and inhibition of the activity of thyroid peroxidase induced by antiangiogenesis of sunitinib.
  • Ma Yunhua, Chen Min
    2015, 17(5): 367.
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    Antineutrophil cytoplasmic antibody (ANCA) associated small vessel vasculitis (AAV) induced by propylthiouracil (PTU) accounted for 80%-90% of vasculitis due to anti hyperthyroidism drugs. AAV is the disease which involved the systems of respiration, kidney, skin, muscle, nerve, stomach and intestine and ophthalmology and otorhinolaryngology. The clinical manifestations of AAV include fever, weakness, weight loss, myalgia and arthralgia, purpuric skin injury, hematuresis, conjunctivitis, pulmonary alveolar hemorrhage, and acute renal failure, can be even life-threatening. Laboratory examination showed positive ANCA. The mechanism of AAV induced by PTU may be related to interaction of PTU and myeloperoxidase (MPO). Long-term use of PTU may be the high risk factor in AAV. Serum anti-MPO antibody positive, anti-MPO antibody titer and the affinity to MPO antibody may be also related to PTU-AAV. The diagnostic code of PTU-AAV include (1) appearance of clinical symptoms of small vessel vasculitis and have the specific relationship between symptoms and medication time; (2) ANCA test show positive or titer elevating; (3) tissue biopsy shows inflammatory reaction and necrosis in small vessels, and renal needle biopsy shows focal segmental necrosis of cellulose and /or crescentic glomerulonephritis; (4) other diseases which may induce vasculitis, such as infection and tumor can be excluded. The main treatments for AAV are withdrawal of PTU timely and rational combination of steroids and cytotoxic drugs. The prognosis of PTU-AAV is closely related to the damage range in small vessels. The overall prognosis of PTU-AAV is better than that of primary small vessel vasculitis.
  • Hou Xiaoping, Wei Xuan
    2015, 17(5): 371.
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    Two elderly patients (one was male, 90 years-old; the other female, 63 years-old) with coronary disease and depression received citalopram 20 mg daily for 4 years and 1 year, respectively. The width of their electrocardiogram QT interval was normal. They received diltiazem 15 mg three times daily (the male) and 30 mg three times daily (the female) due to recurrent attacks of angina pectoris. QT interval prolongation was found by electrocardiographic examination on day 4 (the male) and day 83 (the female) of medication with diltiazem, the QT interval/corrected QT interval(QT/QTc) were 448/526 ms (the male) and 430/447 ms (the female), respectively. The QT/QTc in the male patient decreased to 432/510 ms 5 days after diltiazem withdrawal. The QT/QTc in the female patient decreased to 388/406 ms on 35 days after diltiazem′s dosage was halved.
  • Li Zhengrong
    2015, 17(5): 373.
    Abstract ( ) PDF ( )
    A 30-year-old female patient received an IV infusion of cefotaxime sodium 1.0 g for toothache. About 20 minutes later, the patient developed chest tightness, palpitation, and limbs shaking. The drug was immediately stopped and an IV injection of dexamethasone was given. However, the symptoms were not improved and the patient was presented to emergency department in our hospital. On admission, electrocardiogram revealed acute myocardial ischemia, troponin T (TnT) 0.033 μg/L, creatine kinase (CK) 175 U/L, creatine kinase isoenzyme MB (CK-MB) 2.95 μg/L. About 0.5 hour of admission, the patient developed asthmatic symptoms and coughed up pink frothy sputum. Ventilator support, morphine, torasemide, dopamine, nitroglycerin, and diprophylline were given. About 4.5 hours of admission, her symptoms were improved. About 7 hours of admission, TnT was 0.551 μg/L, CK-MB 2.95 μg/L, myohemoglobin 149 μg/L. Five days of admission, ECG returned to normal and 1 week later, TnT, CK-MB and myohemoglobin levels returned to normal.
  • Li Xiaoye, Lyu Qianzhou
    2015, 17(5): 374.
    Abstract ( ) PDF ( )
    A 58-years-old male patient underwent stent implantation in anterior descending coronary artery in emergency angiography because of acute chest pain. After operation, aspirin 100 mg and clopidogrel 75 mg once daily were given. Two weeks later, the patient was hospitalized again due to chest pain.Coronary angiography demonstrated stent thrombosis. Thrombectomy was performed, meanwhile, thrombelastogram revealed that clopidogrel presented low reactivity. Subsequently, the daily dose of clopidogrel was adjusted to 150 mg. One month later, thrombelastogram showed adenosinediphosphate inhibition rate was within the normal range, no chest pain and other symptoms recurred at 3 months of follow-up and coronary angiography showed stent patency.
  • Zhang Yi,Qu Yong
    2015, 17(5): 376.
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    A 61-year-old woman with pain due to bone fracture applied diclofenac diethylamine emulgel over the local skin. About 2 hours after the drug use, red rash appeared on the sites where the medicine was applied and erythema was accompanied by itching and pain on the back, loin and internal side of both thighs. On day 2 of drug use,the patient′s temperature increased to 39.2 ℃. Scarlatiniform rashes appeared on the sites mentioned above. She received antianaphylactic treatment. Three days later, her temperature returned to normal, the erythra decreased, and the itching was alleviated. One week later, the erythra mostly disappeared.
  • Wang Xiaodan, Cao Hongfu
    2015, 17(5): 377.
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    A 65-year-old male patient with diabetes, diabetic nephropathy, and chronic renal insufficiency received treatments of Taxus chinensis medicinal slices (10 g,once daily by mouth), insulin aspart 30 (10 U, thrice daily by subcutaneous injection), insulin glargine (10 U, once every night by subcutaneous injection), pancreatic kininogenase (40 U, once daily by mouth), thioctic acid (0.6 g, once daily by IV injection),  Haikunshenxi  capsules (海昆肾喜胶囊, 0.44 g, thrice daily by mouth),  Niaoduqing  granules (尿毒清颗粒, 5 g, thrice daily by mouth), and compound α-keto acid (4 pills, thrice daily by mouth). The patient developed nausea and vomiting  and convulsion of extremities after 1 h and 4 h of the second treatment of Taxus chinensis medicinal slices. ECG monitoring showed supraventricular tachycardia. Laboratory tests showed serum potassium 6.4 mmol/L.  Recurrent supraventricular tachycardia appeared in the patient. After 5 times of electrical cardioversion and lidocaine and amiodarone treatments, the patient′s arrhythmia was converted to sinus rhythm. Taxus chinensis medicinal slices was stopped and other treatments were continued. Supraventricular tachycardia did not recur.
  • Zhao Yi, Huang Xu, Li Xiaoxia
    2015, 17(5): 379.
    Abstract ( ) PDF ( )
    A 28-year-old female patient with systemic lupus erythematosus received treatments with prednisone, hydroxychloroquine, leflunomide, calcium carbonate  D3, and celecoxib. After 1 month of treatments, she developed itching over whole body, edema of eyelids and face, and generalized urticarial eruption. All drugs were discontinued and methylprednisolone, ebastine, and cetirizine hydrochloride were given. Two weeks later, skin rashes completely disappeared. However, the itching appeared again when the patient was given hydroxychloroquine treatment again for 1 week and disappeared after the drug withdrawal. After that, leflunomide, calcitriol, and calcium carbonate D3 were given again and no rashes recurred.
  • Qiao Zihong
    2015, 17(5): 381.
    Abstract ( ) PDF ( )
    A 56-year-old male patient was given traditional Chinese herbal medicines in the form of decoction for arrhythmia. One week later, Squama Manitis 10 g was added into the prescriptions. The erythema, papules with itching appeared in the left leg the next day. That condition was not controlled by stopping taking Chinese herbal medicines and topical use of compound dexamethasone acetate cream. On the third day, the rash even spread to the trunk, arms and legs. The patient was given oral loratadine 10 mg once daily and vitamin C 0.3 g thrice daily. Twenty days later, the symptoms disappeared. The rash in the left leg appeared again 3 days after the patient took Chinese herbal medicines with Squama Manitis by himself. He was cured by using the same treatment.
  • Zhu Jianhui, Shao Xiying, Wang Zeng
    2015, 17(5): 382.
    Abstract ( ) PDF ( )
    A 32-year-old woman with breast cancer received a postoperative adjuvant chemotherapy with epirubicin plus cyclophosphamide followed by paclitaxel. The drug regimen of paclitaxel was intravenous infusion 120 mg once a week. On the day 6 after the first cycle of paclitaxel treatment, the patient developed bilateral big toenail hollowness, the aperture was about 2 mm. She was given the second cycle of paclitaxel according to the original plan. Six days later, the hollow toenail was worsened with slight pain. Paclitaxel was stopped. Mecobalamin, erythromycin ointment and keeping warm of feet were applied. Four days later, the pain was reduced, and the toenail hollowness did not continue to enlarge.
  • Zhang Hanyu
    2015, 17(5): 383.
    Abstract ( ) PDF ( )
    A 70-year-old man with pneumonia received an IV infusion of ceftizoxime sodium 3 g in 0.9% sodium chloride 250 ml twice daily. Twenty minutes after the first infusion, he developed low back pain, chills and confusion. He presented with moderately jaundiced skin and sclera. Laboratory tests revealed the following results: white blood cell (WBC) count 11×109/L, neutrophil 0.8, red blood cell (RBC) count 3.2×1012/L, hemoglobin 91 g/L, reticulocytes 0.081, total bilirubin 98 μmol/L, indirect bilirubin 80 μmol/L. Direct Coomb′s test(+). He developed strong tea-colored urine. Routine urine tests showed the following results: urine bilirubin (+), occult blood (+++), 0-2 red cells per high power field. Ceftizoxime sodium-induced acute hemolytic anemia was considered. He received hydration and alkalizing of urine. Ceftizoxime sodium was switched to fosfomycin. On day 5, the jaundice disappeared and the color of urine returned to normal. Laboratory tests showed the following results: WBC count 4×109/L, RBC count 4.2×1012/L, hemoglobin 131 g/L, reticulocytes 0.015, total bilirubin 17 μmol/L, indirect bilirubin 10 μmol/L, urine bilirubin (-), occult blood (-), 0-1 red cells per high power field.
  • Ran Mingyue, Mao Min, Li Chunyan, Huang Li
    2015, 17(5): 385.
    Abstract ( ) PDF ( )
    An 80-year-old male patient with hypertension, arteriosclerosis, rheumatic heart disease, and atrial fibrillation long-term daily oral warfarin sodium 3 mg once daily. International normalized ratio (INR) was maintained at 2.00 to 3.00. An intravenous infusion of piperacillin sodium and tazobactam sodium 4.5 g every 8 hours, intramuscular injection of compound aminophenazone and barbital 2 ml, oral loxoprofen sodium 30 mg and other drugs were added to his regimen for pulmonary infection and high fever. Before the drug combination, prothrombin time (PT) was 27 s, and the INR was 2.45. Two days later, the patient developed hemoptysis. The next day, warfarin sodium was stopped. On the second day of discontinuation of warfarin sodium,the patient suddenly felt a severe pain in the left upper abdomen with the sign of palpable mass and tenderness. Meanwhile, the PT was 42 s, and the INR was 4.46. On the next day, abdominal ultrasound examination showed that there was a cystic structure in the left abdominal rectus muscle with the size of 4.5 cm×2.7 cm×1.5 cm, and the internal circular high density shadow in the left rectus muscle was found on abdominal ultrasonography. Left abdominal rectus muscle hematoma was considered. Intramuscular injection of vitamin K1 10 mg once daily was given immediately, and ceftazidime was used instead of piperacillin sodium and tazobactam sodium. Two days later, the patient′s symptoms of abdominal pain disappeared, PT fell to 16 s, INR fell to 1.11. One week later, oral warfarin sodium (initial dose 2.25 mg once daily)was given, and adjusted the dose according to INR. One month later, the abdominal ultrasound examination showed that the size of hematoma significantly decreased (3.5 cm × 0.8 cm).
  • Xu Dongming, Lin Ling
    2015, 17(5): 387.
    Abstract ( ) PDF ( )
    A 20-year-old female patient received oral propylthiouracil (PTU) 100 mg/d for hyperthyroidism. After 2 years, she noticed blood in phlegm and had red eye. PTU-associated vasculitis was diagnosed. PTU was stopped and oral prednisone 20 mg/d was given. Her symptoms improved. Twenty days later, prednisone dosage was reduced to 5 mg/d, hemoptysis appeared again with swelling in the left ear. Laboratory testing showed the following results: free triiodothyronine 5.78 pmol/L, free thyroxine 2.69 pmol/L, thyroid-stimulating hormone 0.007 mU/L, antinuclear antibody 1 ∶  320 (+), spotted type, perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) (+), myeloperoxidase(MPO)79.3 RU/ml, proteinase 3(PR3)2.2 RU/ml. Chest CT shows multiple patchy opacities in both lungs. PTU induced anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis and hyperthyroidism were diagnosed. IV infusion of methylprednisolone 40 mg/d and oral methimazole 5 mg/d were given. Hemoptysis and auricle swelling subsided after one week. Methylprednisolone was switched to oral prednisone. One year later, prednisone was stopped without physician′s advise. Five months later, recurrence of hemoptysis occurred. Laboratory testing showed p-ANCA (+), MPO 72.0 RU/ml, and PR3 2.0 RU/ml. ANCA-associated vasculitis recurrence was considered. Methimazole was stopped and IV infusion of methylprednisolone 40 mg/d was given. Hemoptysis was alleviated obviously after one week and oral prednisone was continued. Five months later, red maculopapule appeared on her right auricle. MPO was 112.0 RU/ml. Oral methotrexate 10 mg once weekly was added. Red maculopapule faded and MPO was reduced to 78.0 RU/ml after 6 months. Methotrexate was withdrawn.
  • Wang Yongzhen, Wang Yanhua, Na Shijie, Dai Feng, Huang Guojin, Hu Di
    2015, 17(5): 389.
    Abstract ( ) PDF ( )
    A 54-year-old male patient with chronic hepatitis B and liver cirrhosis with upper gastrointestinal hemorrhage was treated with the percutaneous transhepatic embolization of gastroesophageal varices and partial splenic embolization. He received an intravenous ioversol injection 160 ml. About 6.5 hours after intervention, the patient became blind in both eyes. Magnetic resonance imaging (MRI) showed widely fresh brain infarction, but nothing abnormal was found in brain computed tomography. He was given oxygen and dexamethasone, sodium aescinate, mannitol, alprostadil, vinpocetine, ligustrazine, monosialotetrahexosyl ganglioside sodium. Fifty-eight hours after blindness, the eyesight was completely resumed. Two weeks later, MRI showed that the range of cerebral infarcts became smaller, signal intensity was reduced. Fourteen months later, the gastrointestinal hemorrhage did not occur and the eyesight was normal.
  • Liao Wanmin, Ai Ling, Zhang Xianwei
    2015, 17(5): 391.
    Abstract ( ) PDF ( )
    A 49 year-old female underwent laparoscopic uterine myoma plus hysteroscopy operation under general anesthesia. She received an intravenous injection of dezocine 2.5 mg because of pain after anesthesia recovery. About 20 seconds later she fell asleep. She developed orbit-pressing reflex slowing, cyanosis of lips, and reduced amplitude of respiration. Her pulse oxygen saturation was 0.80, breathing rate was 7 beats/min. The patient received nasal catheter oxygen immediately. Her pulse oxygen saturation returned to 1.00, breathing rate increased to 16/min one minute later, and regained consciousness gradually.
  • Yang Qiuya, Dong Yafen, Hu Bin
    2015, 17(5): 393.
    Abstract ( ) PDF ( )
    A 51-year-old male patient with hyperlipidemia, uremia, uremic cardiomyopathy, hypertension, osteoporosis and type 2 diabetes received atorvastatin calcium 20 mg/d, olmesartan 20 mg/d, nifedipine 30 mg/d, isosorbide 5-mononitrate 40 mg/d, calcitriol 0.5 μg/d, calcium acetate 0.6 g/d. In addition, the patient received hypodermic injection of insulin according to blood sugar level, and maintained peritoneal dialysis. The patient stopped using atorvastatin and switched to bezafibrate dispersible tablets 0.2 g three time daily because of his high levels of total cholesterol (7.0 mmol/L) and triacylglycerol (9.9 mmol/L) . On day 4 of changing the prescription, the patient complained of whole body pain. On day 6 of changing the prescription, the patient became anxious, irritable, and had darkened peritoneal dialysis fluid. Laboratory test showed the following values: white blood cell count (WBC) 33.0×109/L, neutrophil 0.95, creatine kinase (CK) >10 000 U/L, myoglobin 2 876 μg/L, alanine aminotransferase (ALT) 460 U/L, urea 20.9 mmol/L, and creatinine (Cr) 1 294 μmol/L on day 7 of changing medical prescription. The patient was diagnosed as rhabdomyolysis due to bezafibrate. Bezafibrate was withdrawn on the same day. He received the symptomatic treatments including liver and kidney protection, nourishing myocardium, and vein-vein hemodialysis besides continuing to take the other drugs mentioned above. On day 7 of stopping bezafibrate the patient′s mental symptoms improved. Laboratory test showed the following values: WBC 16.0×109/L, neutrophil 0.81, CK 154 U/L, myoglobin 288 μg/L, ALT 21 U/L, urea 12.0 mmol/L, and Cr 564 μmol/L on day 16 of stopping bezafibrate.The patient did not complain of pain, the symptoms of anxiety and irritability did not appear until the day 60 of drug withdrawal.
  • Li Ying, Liu Ying, Shi Qiang, Wang Xiaoling
    2015, 17(5): 395.
    Abstract ( ) PDF ( )
    A 25-day-old male neonate suspected of having congenital heart disease underwent echocardiographic examination. The physician prescribed chloral hydrate mixture 10 ml, oral 2 ml before the examination. The pharmacist just told to take 2 ml, without written dosage indication. Before the ultrasound examination, the parent administered the newborn 10 ml chloral hydrate mixture, and then, he developed apnea during the examination. He received tracheal intubation and intravenous infusion of aminophylline. The next day, he was given oxygen inhalation through nasal tube. Six days later, the infant′s condition was improved.
  • Liu Liang, Wang Jimei
    2015, 17(5): 396.
    Abstract ( ) PDF ( )
    A 5-year-old girl with fever received nimesulide granules 50 mg which was bought by her parents. Sixteen hours later she developed abdominal pain and gross hematuria. She received nimesulide granules 50 mg again because of fever. About 3 hours later the above-mentioned symptoms  recurred. Laboratory tests showed the following values: white blood cell count (WBC) 24.5×109/L, Neutrophil count (NEU) 14.5×109/L, red blood cell count (RBC) 1.6×1012/L, and hemoglobin (Hb) 193×109/L. She was diagnosed as hemolytic anemia in the other hospital and received the fluid therapy and human immune globulin and dexamethasone for 5 days. Then her urine color turned light, RBC and Hb increased to 2.7×1012/L and 83.0 g/L, respectively. One day 7 of morbidity she was hospitalized in our hospital. Blood routine examination showed the following values: WBC 18.7×109/L, NEU 10.5×109/L, RBC 2.8×1012/L, Hb 93.0 g/L, PLT 521×109/L,and absolute value of  reticulocyte (Ret) 320×109/L. She received azithromycin for infection, and symptomatic treatment (dexamethasone and glutathione). Ten days later, the blood routine examination showed: WBC 17.2×109/L, NEU 12.6×109/L, RBC 3.5×1012/L, Hb 114.0 g/L, PLT 575×109/L and Ret 150×109/L. Hematuria did not occur again in this patient.