抗生素致过敏性休克

近年来临床应用抗生素逐渐增多,因抗生素致过敏性休克常有报道,现摘要如下.1 甲磺酸培氟沙星葡萄糖注射液男,70岁.因右侧自发性气胸、慢性阻塞性肺疾病入院后即刻给氧,胸膜腔闭式引流术,同时采取了有创治疗,给予甲磺酸培氟沙星葡萄糖注射液(规格为0.4g甲磺酸培氟沙星5％葡萄糖注射液100ml,批号20040601,海南长安国际制药有限公司生产)0.4g静脉滴注,滴注速度30滴/min.     

甲型副伤寒二例误诊为急性阑尾炎

【例1】　女,2 4岁。因突发右下腹痛1天入院。患者闭经5 0天,诊断为早期妊娠并急性阑尾炎。急诊行阑尾切除术。术中见右下腹有较多渗液,阑尾正常,回盲部未见明显异常。术后仍高热,行血培养证实为甲型副伤寒。予抗感染治疗3周并行人工流产术,痊愈出院。【例2】　男,3 8岁。因头痛并发热1周,突发右下腹痛1天入院。诊断为急性阑尾炎,急诊行阑尾切除术。术中见阑尾炎症不明显,回肠末端10cm处系膜对侧缘有3cm×2cm大小的脓苔覆盖,有较多渗液。术中怀疑为伤寒病,术后血培养证实为甲型副伤寒。治疗3周痊愈出院。甲型副伤寒是沙门菌A组杆菌引起的一…     

甲磺酸培氟沙星致过敏反应

1　病例资料女 ,5 9岁。因多饮、多尿 11年 ,尿频、尿急 2周入院。诊断为 2型糖尿病、泌尿系感染。既往无药物过敏史。入院后给予甲磺酸培氟沙星葡萄糖注射液静脉滴注 ,滴速 30滴 /分。输入液体约 4 0分钟后 ,患者诉恶心、呕吐、头痛、眩晕、腰部钝痛。立即更换液路 ,给予 0 9     

甲型副伤寒早期临床特点

近年来 ,温州地区甲型副伤寒发病较前增多 ,但甲型副伤寒早期缺乏典型临床表现 ,易误诊 ;现对1997年以来本院收治的甲型副伤寒患者早期特点作一回顾性分析。1临床资料1.1病例选择 (1)患者入院时病程不超过1周。 (2)入院后经血培养或骨髓培养明确为甲型副伤寒患者。1.2一般资料甲型副伤寒患者44例 ,男27例 ,女17例。年龄5～80岁 ,平均25.84岁。在春、夏、秋、冬季发病的分别有6、10、12、16例。其中37例患者发病前无明显诱因 ,4例受凉后起病 ,2例食海鲜后起病 ,1例在手术后起病。1.3入院前临床症状入院前44例患者均有发热 ,其中表现为稽留热2…     

舟山海岛地区118例甲型副伤寒临床分析

在 1 998年前后 ,由于缺水 ,我区发生了甲型副伤寒流行 ,我院传染科收治患者近 2 0 0例 ,现对经血培养确诊的 1 1 8例甲型副伤寒临床分析如下。1　临床资料1 .1　一般情况　男 75例 ,女 43例。年龄在 4～ 5 2岁 ,平均 2 6 .3岁。自发病至入院时间 3～ 7天 ,平均 4.1天。患者在入院前已作不同程度处理。1 .2　确诊条件　除发热、相对缓脉、无欲貌等临床特点 ,血培养均有甲型副伤寒杆菌生长。1 .3　临床特点 (见表 1 )。在热型中 ,以弛张热为主 ,占 5 6 .8% ,稽留热为 1 6 .1 % ,余为低热和不规则热。肝脾大的确定均以 B超检查为准 ,共查 5 3…     

药物所致失眠

男,72岁.因前列腺增生给予氨苄西林5.0 g＋5%葡萄糖液500 ml,培氟沙星注射液100 ml（400 mg）/d静滴.连用2 d后,出现恶心、胸闷、心慌、呕吐和失眠.停用培氟沙星,改用磷霉素,其他并用药继用,未作特殊处理,上述症状好转.     

副伤寒甲的肾脏损害

副伤寒甲是由甲型副伤寒杆菌引起的急性肠道传染病 ,其病理和临床表现与伤寒类似 ,但较轻 [1 ] ,以持续性菌血症、网状内皮系统受损、远端回肠微小脓肿及溃疡形成为基本特征 ,肾脏损害也不少见。 1999年 1月～ 10月我们收治住院治疗副伤寒甲患者 16 5例 ,其中合并肾脏损害者 37例 ,报告如下。1　临床资料1.1　一般资料　 16 5例患者均经血培养或 (及 )骨髓培养证实甲型副伤寒杆菌生长。住院后检查血、尿、便常规 ,肝、肾功能 ,心肌酶谱 ,X线胸片 ,心电图 ,腹部及双肾 B超。根据有无尿常规及肾功能异常分为合并肾脏损害组 (简称肾损组 )及无…     

氧氟沙星、头孢呱酮治疗耐药甲型副伤寒76例疗效观察

我院 1 998年 8月～ 2 0 0 1年 1 2月对耐药甲型副伤寒分别采用了氧氟沙星、头孢呱酮治疗 ,取得了较好的疗效 ,现报告如下。1　资料料和方法将临床诊断为伤寒、副伤寒患者随机分为 2周疗法 3组及 5日疗法组 ,分别给予国产及进口氧氟沙星、头孢呱酮治疗。甲型副伤寒 1 66例 ,其中资料完整且经血培养或骨髓培养证实为耐氯霉素的甲型副伤寒 76例 ,男 37例 ,女 39例 ,年龄1 4～ 62岁。 4组患者在年龄、治疗前体温 ,治疗前病程等诸方面均相似 ,具可比性。Ａ组 :国产氧氟沙星胶囊 (江苏扬子江药业集团生产 ) 0 2ｇ ,2次 /ｄ ,疗程 2周者 1 8例 ,…     

甲磺酸培氟沙星葡萄糖注射液致急性跟腱炎1例分析

对甲磺酸培氟沙星葡萄糖注射液致急性跟腱炎1例分析如下。 1病历摘要 男，56岁。因发热、腹痛、腹泻、排脓血便1d入院。发病前曾有不洁饮食史，无踝关节外伤病史。查体：T36．5℃、P80次／min。     

典沙与香丹注射液存在配伍禁忌

典沙通用名是甲磺酸培氟沙星葡萄糖注射液。甲磺酸培氟沙星为喹诺酮类抗菌药,具有广谱抗菌作用。主要用于敏感菌所致的各种感染,临床应用广泛。香丹注射液中主要成分是丹参、降香,其主要功能是扩张血管,增进冠状动脉血流量。我们在临床工作中发现2种药物之间存在配伍禁忌,现报道如下。临床工作中发现静滴5%葡萄糖300 ml+香丹注射液20 ml的混合液后换成典沙0.4 g的溶液后,输液管中立即出现白色絮状浑浊物。实验方法及结果为进一步证实甲磺酸培氟沙星葡萄糖注射液(典沙)与香丹之间存在配伍禁忌,我们用一次性注射器抽取典沙2 ml与香丹注射液2 m…     

Brucellosis (Mediterranean fever, Gibralter fever, Malta fever, Cyprus fever, undulant fever, typhomalarial fever)

This series is based on the Infectious Diseases section of the web site Refugee Health ∼ Immigrant Health, available on the World Wide Web at http://www.baylor.edu/~Charles_Kemp/Refugee_Health.htm . The site was developed through a contract with the Texas Department of Health as part of an ongoing effort to improve the health of refugees and immigrants.     

Metal fume fever and polymer fume fever

Abstract

Introduction. Inhalational exposure to metal-containing fumes generated by welding and related processes may result in the development of the clinical syndrome known as “metal fume fever.” Polymer fume fever is a separate and distinct but related disorder that has been associated with inhalational exposure to specific fluorinated polymer products, such as polytetrafluoroethylene or Teflon^®. We undertook a review of the peer-reviewed medical literature as it relates to these two disease entities in order to describe their epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, prevention, and prognosis. Methodology. We performed a search of the PubMed (www.pubmed.com) and Ovid MEDLINE (ovidsp.tx.ovid.com) databases for keywords “metal fume fever,” “polymer fume fever,” and “fume fever,” covering the period 1946 to September 2014, which resulted in a total of 141 citations. Limiting the search to articles published in the English language yielded 115 citations. These 115 articles were manually reviewed for relevance. In addition, the reference lists in each article retrieved were reviewed for additional relevant references. This left 48 relevant citations. Epidemiology. Metal fume fever occurs most commonly as an occupational disease in individuals who perform welding and other metal-joining activities for a living. It is estimated that 1,500–2,500 cases of metal fume fever occur annually in the United States. Polymer fume fever was initially identified as an occupational disease but increased regulations have resulted in decreased incidence in the occupational setting. Overheating of Teflon^®-coated cookware is one of the more common mechanisms for exposure. Pathophysiology. While the precise pathophysiology associated with the development of metal fume fever is yet to be elucidated, suggested pathophysiologic mechanisms include pro-inflammatory cytokine release, neutrophil activation, and oxygen radical formation. The pathophysiologic mechanism for polymer fume fever has not been definitively elucidated but may involve similar mechanisms to those proposed for metal fume fever. Clinical presentation. Metal fume fever typically presents with generally non-specific complaints including influenza-like symptoms, fever, shaking chills, arthalgias, myalgias, headache, and malaise. Onset of symptoms typically occurs 4–10 h following the exposure to metal-containing fumes. While metal fume fever is typically benign and self-limited, severe cases of the disease have been reported. In patients with ongoing metal fume exposure over the course of a workweek, tachyphylaxis occurs resulting in improvement in symptoms over the course of the workweek and maximal symptoms occurring after an exposure-free period such as a weekend. The clinical presentation of polymer fume fever is indistinguishable from metal fume fever, with an exposure history being necessary to distinguish the two entities. Diagnosis. Chest radiographs are typically normal in cases of metal fume fever and polymer fume fever; however, mild vascular congestion may be demonstrated and severe cases may feature diffuse patchy infiltrates. Laboratory studies are typically not necessary but may demonstrate leukocytosis with leftward shift or an elevated erythrocyte sedimentation rate. Treatment. The primary treatment for both metal fume fever and polymer fume fever is supportive and directed at symptom relief. Oral hydration, rest, and the use of antipyretics and anti-inflammatory medications (e.g., non-steroidal anti-inflammatory drugs and aspirin) are recommended. A careful workplace exposure assessment analysis conducted by an occupational medicine specialist or clinical toxicologist in concert with a qualified industrial hygienist should be performed. Prevention. A careful workplace exposure assessment including measurement of ambient zinc and other metal (e.g., chrome, nickel, copper and manganese) fume concentrations or concentrations of fluorocarbon polymer decomposition products at different locations within the workplace should be performed. Prognosis. Metal fume fever is typically a benign and self-limited disease entity that resolves over 12–48 h following cessation of exposure. Conclusions. Metal and polymer fume fevers generally follow a benign course with spontaneous resolution of symptoms, though both have the potential to be serious, especially in those with significant preexisting cardiorespiratory disease.     

Humidifier fever

Pollution of air ventilation and conditioning systems by microorganisms and products of their activity can lead to the development of infectious (legionnaires' disease) and allergic (humidifier fever) diseases. Clinical, immunological and hygienic investigations under natural conditions of 72 persons working in offices helped to study a respiratory disease which was similar to humidifier fever. The removal of dust and mud from the system and thorough cleaning of all conditioned rooms put an end to this disease.