2016 Volume 18 Issue 1 Published: 28 February 2016
  

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  • Effect of different doses of acyclovir on renal function and its mechanism in mice
    Yuan Tangjuan, Xu Jiadong, Gu Lili, Liang Pei, Lu Hong
    2016, 18(1): 8.
    Abstract ( ) PDF ( )
    ObjectiveTo explore the effect of different dosage of acyclovir (ACV) on renal function and its mechanism in mice.MethodsThirty ICR mice were divided into the control, ACV 150 μg/g and 600 μg/g groups by complete randomization method. Each group comprised 10 mice. The mice in the ACV 150 and 600 μg/g groups were injected with different dosage of ACV, the control group were injected with same volume of 0.9% sodium chloride via caudal vein once daily for 7 days. The mice′ body weight before the first medication and after the last medication was weighed. The levels of serum creatinine (Scr) and urea nitrogen (BUN) after medication were detected. The mice were sacrificed after collecting the blood samples. The mice kidneys were weighed and the renal coefficient was calculated. One kidney was used for pathologic examinations, and the other was for detection of expression of kidney injury factor-1 (KIM-1), interleukin-6 (IL-6), tumor necrosis factor-ɑ (TNF-α) and transforming growth factor-β1 (TGF-β1) by immunohistochemical Envision two-step method. The expression score was calculated according to the staining intensity and the percentage of positive cells.ResultsOn day 7 of medication, the body weight of mice in the ACV 150, 600 μg/g groups were lower than that in the control group ［(29.0±0.59) g, (23.6±3.0) g vs. (31.9±2.4) g, P<0.05, P<0.01］, the renal coefficient and the levels of BUN and Scr in ACV 600 μg/g group were higher than those in the control group ［(8.52±0.77)% vs. (6.04±0.71)%，P<0.01; (204 74) μmol/L vs. (133±30) μmol/L, P<0.01; (13.8±2.8) mmol/L vs. (6.9±1.2) mmol/L, P<0.05］. There were renal tubular dilatation and few inflammatory response cell in renal interstitium in the ACV 150 μg/g group and infiltration of flammatory cells in renal interstitium. There were infiltration of flammatory cells and fibroplasia in renal interstitium and some renal tubular deformation and necrosis in ACV 600 μg/g group. The expressions of KIM-1, IL-6, TNF- α and TGF-β1 in renal tissues of mice in the ACV 150 and 600 μg/g groups were all positive. The expression score of KIM-1 in ACV 150 and 600 μg/g groups were higher than that in the control group ［(2.5±1.5), (4.2±2.1) vs. (1.0±3.2)，both P<0.05］. The expression scores of IL-6,TNF-αand TGF-β1 in the ACV 600 μg/g were higher than those in the control group ［(1.5±0.5) vs. (0.2±1.5), (6.5±1.5) vs. (3.0±2.3), (3.5±2.5) vs. (1.2±2.7), all P<0.05］ . ConclusionsThe doses of ACV 150 and 600 μg/g can cause different degree of renal tubular damage and interstitial inflammation in mice. The renal toxicity of ACV may be related to the apoptosis induced by oxidative stress.
  • Effect of cyclosporin treatment on serum creatinine levels in patients with nephrotic syndrome
    Lao Haiyan, Liu Shuangxin, Ma Jianchao, Pan Yuhua, Huo Qihua, Yang Min
    2016, 18(1): 15.
    Abstract ( ) PDF ( )
    ObjectiveTo investigate the effect of cyclosporine on serum creatinine (Scr) levels in patients with nephrotic syndrome.MethodsThe medical record data of patients, who received the treatment with cyclosporine, diagnosed as nephrotic syndrome by renal biopsy, and hospitalized in Guangdong General Hospital from April 2010 to June 2014, were collected and retrospectively studied. Before treatment, all patients′ Scr were less than 200 μmol/L. Increase of the Scr levels by more than 10%-20%, 21%-30%, and >30% of the baseline value were defined as mild, moderate, and severe increase, respectively (severe increase of Scr is considered as renal toxicity). Changes of Scr levels before and after cyclosporine treatment, relationship between the blood concentration of cyclosporine and increase of Scr were analyzed.ResultsA total of 78 patients were enrolled in this study. Of them, 52 were males and 26 were females with age from 14 to 77 years and an average age was (43±20) years. From the results of pathological types, 14 cases had minor lesion, 12 cases had focal segmental glomerulosclerosis, and 52 cases had membranous nephropathy. The average level of Scr before treatment was (94±48) μmol/L. After one week treatment, the average level of Scr in 78 patients was (103±61) μmol/L and the difference was statistically significant compared with that before treatment (P<0.05). Of the 78 patients, 30 cases (38.5%) had increased Scr levels; mild, moderate, and severe increase was seen in 9, 11 and 10 patients respectively. The incidence of renal toxicity was 12.8% (10/78). There were no statistically significant differences in Scr levels between 1, 3, and 6 months of treatment (all P> 0.05). In patients with different pathological types including minor lesion, focal segmental glomerulosclerosis, and membranous nephropathy, the incidence of Scr increase were 28.6% (4/14), 33.3% (4/12), and 42.3% (22/52), respectively (P>0.05) and the incidence rate of renal toxicity were 7.1% (1/14), 16.7% (2/12), and 13.5% (7/52), respectively (P>0.05). The incidence of increase of Scr rose gradually with the increase of cyclospo-rine concentration. In patients with cyclosporine concentrations of ≤200 ng/ml and >200 ng/ml, the incidence of increase or severe increase of Scr were 32.2% (19/59) and 57.9%, respectively (χ2=4.008，P=0.045); the incidence of renal toxicity was 8.5% (5/59) and 26.3% (5/19), respectively (P>0.05).ConclusionsSerum creatinine may increase mildly to moderately at early stage of treatment with cyclosporine in patients with nephrotic syndrome and could be controlled effectively with timely intervention. The increase of Scr may be related to blood cyclosporin concentration. Blood cyclosporin concentration should be monitored regularly during the treatment and the drug dosage should be adjusted according to the result of monitoring.
  • Incidence of severe adverse reactions of cetuximab combined with chemotherapeutic drugs or chemotherapeutic drugs alone in treatment of colorectal cancer: a Meta-analysis
    Wang Chuan, Liu Min, Li Zhongdong
    2016, 18(1): 19.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the incidence of equal to or greater than grade 3 adverse reactions of cetuximab combined with chemotherapeutic drugs or only chemotherapeutic drugs in treatment of patients with advanced colorectal cancer (ACRC)or metastatic colorectal cancer (mCRC).MethodsThe databases of MEDLINE, PubMed, Embase, Cochrane Library, China National Knowledge Infrastruc-ture, Wanfang Database and Vip Database from the  inception to September 2014 were searched. The randomized controlled trial (RCT) which were about cetuximab combined with chemotherapy drugs (experimental group) or only chemotherapy drugs (control group) in treatment of patients with ACRC or mCRC were collected. The software of Review Manager 5.3 was used for meta-analysis. The incidence of equal to or greater than grade 3 adverse reactions of cetuximab combined with chemotherapy drugs or only chemotherapy drugs between the two groups were compared. The results were shown by odds ratio (OR) and 95% confidence intervals (CI).ResultsA total of 14 papers were enrolled into this Meta-analysis. There were 9 RCTs without the blinding design, 3 RCTs without the number of lost and 2 RCTs without the patients' basic information out of the 14 papers. The result of the test of heterogeneity showed no significant heterogeneity among the RCTs. A total of 9 876 patients were enrolled into the Meta-analysis, including 4 927 patients in the experimental group and 4 949 in the control group. The incidence of 9 kinds of ≥3 grade of adverse reactions among the 11 adverse reactions which reported in the 14 papers in the experimental group were higher than those of the control group, such as acneform rash ［14.2% (695/4 886) vs. 0.2% (12/4 926), OR＝57.03, 95% CI: 33.85-96.10, P＜0.001］, oral mucositis ［5.4% (134/2 466) vs. 1.9% (48/2507), OR＝2.97, 95% CI: 2.13-4.16, P＜0.001］, hand-foot syndrome ［7.9% (114/1 439) vs. 3.1% (45/1 436), OR＝2.68, 95%CI: 1.88-3.83, P＜0.001］, anaphylactic reaction ［5.2% (102/1 973) vs. 1.9% (39/2 014), OR＝2.66, 95%CI: 1.84-3.86, P＜0.001］, anorexia ［4.3% (124/2 878) vs. 2.4% (70/2 914), OR＝1.82, 95%CI: 1.35-2.45, P＜0.001］, diarrhea ［17.9% (876/4886) vs. 12.6%(539/4926), OR＝1.80, 95% CI: 1.60-2.02, P＜0.001］, fatigue ［6.4% (242/3 793) vs. 4.2% (162/3 818), OR＝1.53, 95% CI: 1.24-1.87, P＜0.001］, nausea and vomiting ［8.4% (380/4 548) vs. 7.1% (325/4 590), OR＝1.22, 95%CI: 1.04-1.42, P<0.001］, and leucopenia ［17.8% (869/4 886) vs. 16.1% (794/4 926), OR＝1.14, 95%CI: 1.02-1.27, P=0.02］. There was no significant difference in the incidence of anemia between the experiment group and the control group ［2.6% (33/1 258) vs. 2.4% (29/1 231), OR＝1.11, 95% CI: 0.68-1.83, P=0.67］. The incidence of peripheral neuropathy in the experiment group was lower than that in the control group［10.5% (170/1 620) vs. 14.7% (237/1 608), OR＝0.67, 95%CI: 0.54-0.83, P＜0.001］. The sensibility analysis showed the above-mentioned results were steady and dependable.  ConclusionComparison with only using chemotherapeutic drugs in treatment of patients with ACRC or mCRC, cetuximab combined with chemotherapy drugs may increase the incidence of ≥ 3 grade adverse reactions except severe anemia and severe peripheral neuropathy.
  • A randomized controlled trial of warfarin anti-coagulation efficacy and safety of clinical pharmacist-participated anticoagulation management for patients with atrial fibrillation after percutaneous balloon mitral valvuloplasty
    Li Zhengrong, Wang Ling, Shi Zengcheng, Bao Yulin
    2016, 18(1): 26.
    Abstract ( ) PDF ( )
    ObjectiveTo explore the warfarin anti-coagulation effect and safety of clinical pharmacist-participated anticoagulation management service (AMS) on patients with atrial fibrillation after percutaneous balloon mitral valvuloplasty(PBMV).MethodsThe patients who underwent PBMV were divided into trial group and control group by random number table. The patients in the trial group received the clinical pharmacist-participated AMS. The clinical pharmacist provided adjusted warfarin dosage suggestion to clinician and warfarin anticoagulant education to the patients and their family members. The patients in the control group received warfarin following the visiting doctor′s advice. Anticoagulant effect indicators included international normalized ratio (INR) compliance rate, effective anticoagulation rate, anticoagulant deficiency rate and excessive anticoagulation rate. Safety evaluation indicators were embolism and bleeding events during the anticoagulant therapy.ResultsA total of 131 patients were enrolled in the study. The trial group comprised 68 and the control group 63 patients, respectively. The differences in the patients′ age, sex composition, body weight, smoking and drinking habits, degree of mitral stenosis, combined disease, baseline INR, and preliminary warfarin dosage after PBMV were not significant between the 2 groups (all P＞0.05). The INR compliance rate in the trial group and the control group were  53.3％ (217/407) and 41.8％ (155/371), respectively (P=0.001); effective anticoagulation rates were  55.9％ (38/68) and 33.3％ (21/63), respectively (P=0.016); anticoagulant deficiency rate were 19.9％ (81/407) and 27.8％ (103/371), respectively (P=0.003); and the excessive anticoagulation rates were 7.9％(32/407) and 14.0％(52/371), respectively (P=0.006). There were 6 and 9 patients developed minor bleeding events and each was one slight embolism in the trial group and the control group, respectively. The incidence rate of adverse reactions in the trial group (10.3%) was lower than that in the control group (15.9%), but the difference was not significant.ConclusionThe clinical pharmacist-participated AMS may increase the INR compliance rate and the effective anticoagulation rate, decrease the anticoagulant deficiency rate and the excessive anticoagulation rate, and help to increase the effectiveness and safety of warfarin treatment in the patients with atrial fibrillation after PBMV.
  • Analysis of efficacy and safety of subcutaneous injection of bortezomib in patients with POEMS syndrome
    Zhao Hong, Hui Wuhan, Ji Bingxin, Hu Ronghua, Sun Wanling, Wan Suigui, Su Li
    2016, 18(1): 31.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate the effectiveness and safety of subcutaneous injection of bortezomib in patients with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes (POEMS) syndrome.MethodsSince January 2013, patients who  were newly diagnosed with POEMS syndrome in hematology department of Xuanwu Hospital of Capital Medical University were given treatments with subcutaneous injection of bortezomib 1.3 mg/(m2·d) on day 1, 4, 8, 11 and dexamethasone 20 mg/d on day 1, 2, 4, 5, 8, 9, 11, 12 for a period of 28 days. The treatments included no more than 4 cycles. The effects and adverse reactions/events of the treatments were observed.ResultsUntil April 2015, 6 patients with POEMS syndrome were admitted. These patients aged from 37 to 66 years included 1 male, 5 female. All patients first presented with polyneuropathy, accompanied by monoclonal gammopathy, organomegaly, edema, endocrinopathy and pigment in skins. Optic disc edema was found in 4 patients and 3 patients had bone lesions. After 2 to 4 cycles of treatments, peripheral neuropathy was improved in 5 patients. Monoclonal gammopathy disappeared in 5 patients. Organomegaly, edema, endocrinopathy and skin changes recovered to different degree in all 6 patients. Recovery of optic disc edema was found in all 4 patients. Adverse reactions/events happened in 6 patients during the therapy. Peripheral neuropathy of 1 and 2 grade were reported in 3 patients. Three patients developed 1 and 2 grade of gastrointestinal reactions during treatments. Three patients developed respiratory tract infection. One patient developed mild anemia. One patient developed abnormal liver function. No patient discontinued therapy because of adverse events.ConclusionSubcutaneous injection of bortezomib may be an effective and safe treatment for POEMS syndrome.
  • Effect of nucleoside/nucleotide  analogues on kidney function in patient with chronic hepatitis B
    Xu Yong, Feng Jihong
    2016, 18(1): 35.
    Abstract ( ) PDF ( )
    Nucleoside/nucleotide analogues (NAs) which used to treat chronic hepatitis B and had been in the domestic market include adefovir dipivoxil (ADV), tenofovir (TDF), lamivudine ( LAM), telbivudine (LDT) and entecavir (ETV).  ADV and TDF have nephrotoxicity , LAM and ETV have a lesser effects on kidney function , and LDT has certain effect of improving kidney function. The diagnostic criteria of kidney injury due to NAs are serum creatinine (Scr) level higher than that of the baseline value (＞44.2 μmol/L) or serum phosphorus level lower than that of the baseline value (＜0.5 mmol/L) on two successive detections. The incidence rate of kidney injury due to ADV was higher than that due to TDF. The clinical manifestation of kidney injury due to ADV and TDF was Fanconi syndrome. The patient develops local or systemic osteodynia, osteoporosis, and amyasthenia, even limitation of activity and halisteresis in serious cases. The laboratory tests show increase in Scr, decrease in serum phosphorus and uric acid. The mechanisms of nephrotoxicity of ADV and TDF are related to injury of renal tubular epithelial cell mitochondria, change of renal tubular transport protein, and accumulation of drugs in proximal convoluted tubule. The nephrotoxicity of NAs are related to dosage, patients′ age, body weight, baseline level of estimated glomerular filtration rate (eGFR), primary disease, genetic factor, diet and drug. The patient who takes ADV or TDF for long term should monitor SCr, serum phosphorus, eGFR, uric acid, microalbuminuria，and glucose in urine regularly. ADV or TDF should be stopped timely in the case of appearance of symptom of kidney injury. The medication should be changed to LDT or ETV. Phosphorus compounds, vitamin D and calcium should be given.
  • Research progress in drug-induced kidney injury in inpatients and its alert system
    Gai Di, Liu Chen, Yan Suying, Wang Yuqin
    2016, 18(1): 41.
    Abstract ( ) PDF ( )
    Acute kidney injury (AKI) is a common clinical critical illness. Several foreign studies showed that patients with drug-induced AKI accounted for 15%-27% of patients with AKI occurred during hospitalization and a domestic research showed that the proportion was 28.9%. The evaluation methods of causality assessment between drugs and AKI are experts judgement or global introspection, Karch & Lasagnar evaluation method, recommended standard for ADR monitoring center of Health Planning Commission of China, and Naranjo Adverse Drug Reaction Probability Scale(NADRPS), etc. The etiology of drug-induced AKI can be divided into 3 categories, including prerenal, renal, and postrenal. Predisposing factors include advanced age, diabetes, hypertension, chronic kidney disease, low serum albumin, etc. Prevention measures are avoiding and correcting all kinds of risk factors, selecting drugs of low toxicity or no toxicity to kidney, and if necessary early dialysis treatment should be given. Development and improvement of computer aided automatic alert system is very important in prevention, early diagnosis and early treatment of AKI.
  • ariability of platelet response caused by clopidogrel
    Zou Jun, Li Xin, Deng Mingfeng, Xie Jin, Huang Linlin
    2016, 18(1): 46.
    Abstract ( ) PDF ( )
    Variability of platelet response (VPR) is the differences of different people in response to antiplatelet drugs. Clopidogrel are commonly used as clinical anti-platelet drugs, it irreversibly blocks the platelet ADP P2Y12 receptor, inhibits the binding of ADP and platelet receptor and inhibits activation of ADP-mediated glycoproteinⅡb/Ⅲa complex, thereby inhibits platelet aggregation. Clopidogrel VPR mechanism is unclear, it may be linked to a combination of internal factors and external factors, external factors include patient race, age, body mass index, compliance, obesity, insulin resistance, disease states and drug interaction; internal factors include the absorption and metabolism, and platelet receptor gene polymorphism. The detection methods of clopidogrel VPR are mainly as vasodilator-stimulated phosphoprotein and adenosine diphosphate ADP as targets for testing. Summarizes evidence based medicine of clopidogrel and finding standard of platelet function testing method are important to implementing individualized treatment and evaluation of the prognosis.
  • Acute liver failure related to fluconazole and voriconazole
    He Cuiyao, Liu Chengjun, Jia Yuntao, Lyu Fengjun
    2016, 18(1): 60.
    Abstract ( ) PDF ( )
    A 2 months and 14 day old boy was hospitalized for drug eruptions and pneumonia. He received an IV infusion of fluconazole 24 mg twice daily because of Candida albicans positive in sputum culture, and plasma 1-3-beta-D dextran 324 ng/L during the processes of anti-infection and anti-allergic treatment. The boy′s liver function was normal and the abdominal ultrasound examination had no abnormality seen before taking fluconazole. On day 5 after administration of fluconazole, the boy developed new rash on the mouth and lower limbs, moderate xanthochromia, pitting edema of skin over the whole body, and obvious abdominal distension after eating foods. Laboratory test showed alanine aminotransferase (ALT) 579 U/L, aspartate aminotransferase (AST) 655 U/L, total bilirubin (TBil) 71.9 μmol/L, direct bilirubin direct(DBil) 48.7 μmol/L, and alkaline phosphatase (ALP) 89 U/L on day 6 after administration of fluconazole. Ultrasound examination showed hepatomegaly and strong echo of strip in right hepatic lobe. On day 7, fluconazole was replaced by IV infusion of voriconazole 28 mg diluted in 5% glucose 15 ml twice daily. On the second day of using voriconazole, laboratory tests revealed the following results: ALT 761 U/L, AST 717 U/L, TBil 132.3μmol/L, DBil 112.4 μmol/L, ALP 104 U/L, prothrombin time 57 s, partially activated prothrombin 88 s, international normalized ratio 4.86, blood ammonia 79 μmol/L and lactic acid 6.5mmol/L. The patient was diagnosed as liver failure. Voriconazole was stopped. The boy received the symptomatic treatments which including liver-protecting and cholagogue agents, reducing blood ammonia, supplying coagulation factors, and 2 times of plasmapheresis. The boy was suggested to consider liver transplantation, because of his liver function had no significant improvement during the 5 days′ treatment. His parents gave up the treatment and discharged by themselves. The boy was died on the second day of discharging which known from follow-up.
  • Thrombocytopenia due to icotinib
    Zhang Xiaoying, Kong Yi, He Min
    2016, 18(1): 62.
    Abstract ( ) PDF ( )
    An 85-year-old woman with lung cancer received icotinib tablet 125 mg three times daily. Her platelet count (PLT) was 216×109/L before medication. On day 7 of administration, her PLT decreased to 107×109/L. On day 11, PLT decreased to 81×109/L, and 73×109/L on day 15. The patient was diagnosed as thrombocytopenia due to icotinib. Icotinib was stopped and Shengxuexiaoban capsule (升血小板胶囊) 1.8 g twice daily was given. Then her PLT was monitored closely. Twenty-four days after drug withdrawal, her PLT was 40×109/L. Forty-two days after drug withdrawal, her PLT returned to 153×109/L. On day 43 of drug withdrawal, the patient recovered to take primary dose of icotinib. The dosage of Shengxuexiaoban capsule increased to 1.8 g three times daily. On the third day of medication once again, the patient′s PLT was 132×109/L. The results of detection of PLT were normal after that.
  • habdomyolysis due to application of levofloxacin and ornidazole
    Qi Yanxia, Qin Yuhua
    2016, 18(1): 64.
    Abstract ( ) PDF ( )
    A 30-year-old female patient with pelvic inflammation received levofloxacin tablets 0.5 g once daily and ornidazole dispersible tablets 0.5 g twice daily for 14 days. On day 13 of drug use, the patient developed aching limbs and fatigue. The symptoms were worsened after drug withdrawal. Laboratory tests on day 12 after drug withdrawal showed the following values: creatine kinase(CK) 939 U/L, creatine kinase isoenzyme(CK-MB) 41.3 U/L, lactate dehydrogenase(LDH) 313 U/L. The patient was diagnosed as rhabdomyolysis. She was informed to drink plenty of water, received sodium bicarbonate tablet (0.5 g, thrice daily) and coenzyme Q10 tablet (10 mg, thrice daily). Two weeks later, the values of CK, CK-MB, and LDH were 96 U/L, 21 U/L, and 287 U/L, respectively. Her symptoms of aching limbs and fatigue disappeared. The results of subsequent visit three months later showed that the above mentioned parameters returned to normal.
  • Anaphylactic shock due to compound paracetamol and amantadine hydrochloride
    Ren Peipei, Fu Ying
    2016, 18(1): 65.
    Abstract ( ) PDF ( )
    A 68-year-old female patient self-medicated with 1 tablet of compound paracetamol and amantadine hydrochloride (each tablet contained acetaminophen 250 mg, amantadine hydrochloride 100 mg, calculus bovis factitious 10 mg, caffeine 15 mg, and chlorpheniramine maleate 2 mg) because of nasal discharge and cough on the second day of trabeculectomy with covering of amniotic membrane in her right eye. About 30 minutes after administration, she developed dizziness, nausea, vomiting, urinary incontinence, itching on her arms and calves, and pale. Her blood pressure was 80/44 mmHg and heart rate was 90 beats/min. Anti-allergic treatments, blood volume expansion, and oxygen mask were given. Thirty minutes later, her blood pressure increased to 90/62 mmHg. The patient′s symptoms gradually alleviated 2 hours later and the blood pressure increased to 106/69 mmHg 6 hours later.
  • Epidermolysis bullosa induced by irbesartan and hydrochlorothiazide
    Deng Ying, Ge Ping
    2016, 18(1): 67.
    Abstract ( ) PDF ( )
    A 61-year-old male with hypertension received oral irbesartan 150 mg/d and levamlodipine besylate 2.5 mg/d. The therapy was replaced with one tablet of irbesartan and hydrochlorothiazide (containing irbesartan 150 mg and hydrochlorothiazide 12.5 mg) once daily and levamlodipine besylate 2.5 mg/d due to poor efficacy. Eight hours after taking the first irbesartan and hydrochlorothiazide, the patient developed erythema in left upper extremity and blister appeared in locoregional skin accompanied by the increase of skin temperature and pain. There were hyperaemia, edema, diffusing red congestive maculopapule and vesicular rash all over the whole patient′s body skin the second day. Bulla was visible in torsos, hands and feet. Skin lesions were severe in chest and upper limbs. He had facial edema and eyelid swelling and was diagnosed as epidermolysis bullosa. Irbesartan and hydrochlorothiazide was stopped and the patient received an IV injection of dexamethasone 5 mg once daily. On day 6, the skin hyperaemia alleviated, the color of skin rashes became dark, and vesicular rash decreased. Dexamethasone was stopped and he was given oral loratadine 10 mg once daily. On day 8, the erythema gradually subsided in torsos、upper extremity and eyelid, skin temperature was normal and a part of skin was scabby. Eleven days later on follow-up, the skin lesion all disappeared.
  • Delayed phlebitis induced by intravenous cefoxitin
    Xing Yuzhi
    2016, 18(1): 68.
    Abstract ( ) PDF ( )
    Two female patients (41 and 28 years old, respectively) received an intravenous infusion of cefoxitin sodium for gallstones and cholecystitis. Abdominal pain was relieved after 21 and 7 days of treatments, then the drug was stopped. Two or 3 days after drug withdrawal, pain and swelling appeared in her both forearms, the point of puncture turned red, and streak-like lesions occurred along the direction of the vessels. Treatments such as raising the wounded limb, immobilization, local spray liquid dressing, and wet compression with magnesium sulfate were given. After 3 or 4 days, redness, swelling, pain, and streak-like lesions basically disappeared.
  • Withdrawal syndrome induced by sudden stop of levodopa
    Zhang Yuqin, Wang Lan, Zhang Bo
    2016, 18(1): 70.
    Abstract ( ) PDF ( )
    A 60-year-old male with Parkinson′s disease for one year suddenly stopped using levodopa (0.25 g，twice daily) by himself. About 3 weeks later, he developed the symptoms of ardent fever, inarticulacy, confusion, increased heart rate (130-138 beats/min), shortness of breath, delirium, aggressive behavior, hypermyotonia, drowsiness, increased tremble, and decreased cognitive ability successively. The results of laboratory test showed increased white blood cell count (16×109/L-28×109/L). The patient agreed to resume taking levodopa (0.25 g, twice daily) about 4 weeks after drug withdrawal by conversations with his family member repeatedly. The patient′s mental ability and muscle tension of limbs returned to normal on day 4 of medication again. The symptom of delirium did not appear and the symptoms of Parkinson′s disease were relieved.
  • Acute interstitial nephritis caused by moxifloxacin and levofloxacin
    Li Yinghui, Hang Yongfu, Liang Yan
    2016, 18(1): 71.
    Abstract ( ) PDF ( )
    A 31-year-old male patient received an oral moxifloxacin 0.4 g once daily for respiratory infection and after 3 days of treatment, his symptoms were not improved and appeared urine decrease. Moxifloxacin was stopped and changed into levofloxacin 0.2 g twice daily by mouth. After 8 days of treatment, the patient′s symptoms was not improved apparently and appeared urinary protein(+), 5-10 erythrocytes/high magnification (HP), 3-5 white blood cells/HP, serum creatinine 419 μmol/L. Renal biopsy showed acute tubular interstitial nephropathy. Drug-induced acute interstitial nephritis-induced by moxifloxacin and levofloxacin was considered. Levofloxacin was stopped and an IV infusion of methylpred-nisolone 250 mg once daily was given, and 3 days later, it was changed into oral prednison 40 mg once daily. After 7 days of treatment, the patient′s blood creatinine was 168  mol/L, urea 13.6 mmol/L, glomerular filtration rate 45.8 ml/min/1.73 m2. The patient got better and was discharged. At 2 months of follow up, the patient′s blood creatinine was 119 μmol/L and urea was 6.2 mmol/L.
  • Anaphylactic shock, liver and kidney injury caused by Shuxuening injection(舒血宁注射液)
    Zhu Jianxin, Ma Liping, Zhao Jihong, Shen Sijing
    2016, 18(1): 74.
    Abstract ( ) PDF ( )
    A 66-year-old male patient with coronary atherosclerotic heart disease received an IV infusion of Shuxuening injection 18 ml+0.9% sodium chloride injection 250 ml once daily after cataract surgery. About 30 minutes after the second infusion start, the patient suddenly experienced chill, whole body pain, nausea and vomiting. His body temperature was 40.2 ℃, heart rate was 110 beats/min, blood pressure was 95/56 mmHg. Laboratory test revealed the following levels: alanine aminotransferase 116 U/L, aspartate aminotransferase 165 U/L, total bilirubin 17.8 μmol/L, direct bilirubin 9.6 μmol/L, urea nitrogen 7.6 mmol/L, and creatinine 110 μmol/L. The patient was diagnosed as anaphylactic shock, liver and kidney injury. Shuxuening injection was stopped. He was treated with intramuscular injection of diphenhydramine 20 mg, IV infusions of dexamethasone 5 mg, IV infusion of glutathione 1.2 g once daily, oral Bailing capsule(百令胶囊) 2 g thrice daily. Two days later, his body temperature was 36.6 ℃, the blood pressure was 124/76 mmHg, and the heart rate was 69 beats/min. The following day, laboratory test showed the following values: alanine aminotransferase 75 U/L, the aspartate aminotransferase 37 U/L, the total bilirubin 8.4 μmol/L, the direct bilirubin 3.0 μmol/L, the urea nitrogen 4.8 mmol/L, and the creatinine 73 μmol/L.
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