华法林抗凝导致皮肤坏死1例

华法林(warfarin)通过抑制维生素K依赖的凝血因子Ⅱ、Ⅷ、Ⅸ和Ⅸ的合成,产生抗凝作用,在使用过程中需定期检测国际标准化比值(INR)评估出血风险.华法林导致的皮肤坏死(warfarin-induced skin necrosis,WISN)是一种罕见的华法林并发症,自1943年首次发现以来,全球仅报道300余例,...     

垂体后叶素导致皮肤坏死1例

l病例 患者,男,55岁,因摔伤确诊右肱骨外科颈粉碎性骨折,于2003年5月24日入院.既往有精神分裂症病史,无药物过敏史及消化道隐患.体查:T 37℃,R 20次min-1,P 80次·min-1,BP 120/80 mmHg,ECG示:窦性心动过速.     

口服去痛片引起大片皮肤坏死1例

本例患者为自服去痛片引起皮肤大片坏死，临床中较为罕见，现报告如下。     

野菜黄花草致皮肤坏死截指1例

目的方法结果结论     

链球菌感染致右下肢广泛性皮肤及皮下坏死一例

患者 男,31岁,右下肢肿痛4天于1994年7月29日入院。入院前4天右小腿胫前区被钢筋碰伤,当时局部疼痛,随即发现约4cm×4cm肿胀,青紫区。第2天肿痛加重,蔓延至小腿、足背及大腿下部。入院检查:体温38.4℃,脉搏92次/分,精神、饮食欠佳,右下肢明显肿胀,小腿内侧及外侧皮色发暗,内踝处出现水泡,表皮破溃溢液,膝以下触痛明显。血化验:白细胞13.6×10~9/L,分泌物培养发现A群链球菌。入院诊断:1.右下肢感染。2.右下肢静脉     

高渗糖治疗糖尿病皮肤多处溃疡1例

1　病案摘要患者男 ,4 2岁。患有 2型糖尿病 1 0余年 ,伴皮肤反复多处溃疡 3年。曾在多家医院诊治 ,进行全身抗炎及局部换药等处理 ,效果欠佳 ,而就诊我队。查体 :消瘦面容 ,双下肢骨突出部位皮肤可见 5个深浅、大小不一溃疡 ,周围质硬、弹性差 ,有的形成窦道 ,面积最大为 5 .0 cm× 7.0 cm,面积最小为 1 .0 cm×0 .8cm,表面污秽 ,腔底有脓性分泌物。检测血常规正常 ,血糖为1 8.3mmol/ L。予普通胰岛素 30 U加入 0 .9%生理盐水 2 5 0 ml,静滴 ,1 / d;局部予清洗及行换药。 2周后血糖下降至1 3.6 mmol/ L ,溃疡分泌物仍较多 ,无肉芽生长。…     

1例复方氨基酸输液外渗致组织坏死的原因分析及护理

在临床护理工作中,输液外渗是静脉输液最常见的并发症之一,大多数经过局部处理或者自然吸收后没有不良后果。但是有一些药物引起的输液外渗,如果不及时采取正确的护理措施,将会发生严重后果,应引起广大护理人员的高度重视。现将一例复方氨基酸输液外渗致组织坏死的原因分析及护理报告如下：患者,男,80岁,因左侧肢体活动不灵10年,右侧肢体活动不灵6年,进食差5个月入院。既往：脑梗死、高血压、糖尿病、冠心病病史。入院时查体：神志清楚,完全性失语,体质消瘦,查体不配合,双上肢屈曲,双下肢伸直,尿失禁,鼻饲饮食两年,期间多次反复出现低蛋白血症。某日护士在其足背浅小静脉输注复方氨基酸后发生输液外渗,当时局部皮肤发红,面积约3×40cm,夜班护士使用雷夫诺尔外敷。     

多西他赛血管外渗致局部皮肤坏死1例

患者，女70岁，系卵巢癌根治术后3年，多程化疗后合并腹水及少量胸水，于2004年6月在我科拟行全身化疗，入院时腹胀，食欲差，查体：浅表淋巴结未及增大。腹部隆，无压痛，未及包块，腹部移动性浊音阳性。胸片示左肺野少量胸水。B超示大量腹水。外周血常规及肝、肾功能均正常。入院后经腹穿刺放腹水腹腔氟尿嘧啶1000mg化疗后，行多西他赛（Docetaxet）联合异环磷酰胺化疗，     

简易外部皮肤扩张术治疗Pilon骨折术后皮肤坏死缺损

摘要： 目的 探讨简易外部皮肤扩张术在治疗 Pilon 骨折术后皮肤坏死中的价值。方法 回顾性分析 2015 年 5 月—2017 年 1 月采用简易外部皮肤扩张术治疗的 12 例 Pilon 骨折术后皮肤坏死缺损患者资料。其中男 10 例, 女 2 例; 年龄 32~58 岁, 平均 （45.30±8.91） 岁; 开放性骨折 4 例, 闭合性骨折 8 例; 缺损部位长约 9.1 cm、 宽约 3.9 cm; 3 例为开放性骨折部位皮肤坏死, 9 例为术后手术切口部位皮肤坏死。皮肤坏死部位彻底清创排除感染后, 克氏针间断穿过皮肤, 在克氏针两端各绕一个无菌橡胶管与对侧创缘的克氏针两端相连接, 给予适度拉力, 拉力大小以两侧皮缘仍有渗血、 皮肤颜色无明显苍白为度, 两端橡胶管以止血钳固定。利用皮肤的延展性和橡胶管的拉力作用使皮肤逐渐延伸, 逐渐缩小并缝合创面。所有患者术后随访 3~6 个月, 观察手术疗效。结果 术后 12 例患者创面均愈合,愈合时间为 2~4 周, 平均 （2.50±0.59） 周。12 例患者全部牵张成功后直接间断缝合, 其中 4 例患者因在外露内置物或肌腱表面牵张缝合, 致使部分牵张皮肤延迟愈合, 再次缝合后愈合。牵张后的皮肤色泽正常、 毛发生长正常、 弹性良好、 无臃肿且触痛觉正常。结论 简易外部皮肤扩张术治疗 Pilon 骨折术后皮肤坏死缺损是一种简单、 有效、 经济的方法, 值得临床推广。     

A phase I pharmacokinetic study of recombinant human tumor necrosis factor administered by a 5-day continuous infusion

Nineteen patients with advanced cancer were entered into a phase I clinical trial of Tumor Necrosis Factor (TNF) which was designed to determine the pharmacokinetic profile, safety, and maximal tolerated dose (MTD) of the recombinant human cytokinein vivo. TNF was administered by continuous infusion for 24 hours followed by pharmacokinetics and a 120-hour infusion repeated every 3 weeks. The initial dose was 40g/m² and was ultimately escalated to 200g/m². A total of forty 5-day cycles were administered to 18 of these patients; and all were evaluable for toxicity. Toxicities in this trial included fever, chills, rigors, hypotension, headaches, seizures, lethargy, weight loss, and malaise. At all dose levels, but more significantly at the highest doses, hematological toxicities were observed and grade 3 neurotoxicity (headache and confusion), and hypotension were noted. Two patients expired during the study, and this was felt to be related to septic episodes. Because of these severe toxicities, 160g/m² was defined as the MTD. At 160g/m² peak serum levels occurred within 5–20 minutes of initiation and were not detectable 1 hour later. No anti-tumor responses were observed. No measurable plasma levels of TNF were observed with the administration of doses of 80g/m². This dose level could be further studied in phase II studies alone and in combination with other agents, utilizing a continuous infusion schedule.     

红霉素致严重药疹并呕吐1例

红霉素是大环内酯类抗菌药物,临床应用广泛,一般无明显的副作用,偶见有轻度风疹、皮疹等不良反应的发生。现报道我院发生的1例红霉素导致的严重药疹并呕吐的罕见病例。     

丹参酮抗D-半乳糖所致小鼠皮肤衰老作用

目的:探讨丹参酮内服抗皮肤衰老作用及机制.方法:清洁级昆明种雌性小鼠每日背部皮下注射D-半乳糖( 1 000 mg·kg -1 )造成小鼠衰老模型,同时灌服丹参酮( 1 500 mg·kg -1 ·d -1 ,750 mg·kg -1 ·d -1 ), 42 d后,测定小鼠背部皮肤组织匀浆中超氧化物歧化酶(SOD)、过氧化脂质代谢产物丙二醛(MDA)及皮肤羟脯氨酸含量,并测定全血中过氧化氢酶(CAT)、谷胱甘肽过氧化物酶( GSH-Px)活性.结果:丹参酮使D-半乳糖所致衰老模型小鼠皮肤中SOD活力、羟脯氨酸含量明显升高,MDA含量显著降低,血中CAT、 GSH-Px活力显著升高,差异均有显著性,而丹参酮( 1 500 mg·kg -1 ·d -1 )组较丹参酮(750 mg·kg -1 ·d -1 )组的上述作用更为明显.结论:丹参酮( 1 500 mg·kg -1 ·d -1 ) 灌服对D-半乳糖所致衰老小鼠皮肤有明显的抗衰老作用,该作用随剂量的增加而增强.     

VSD在乳腺癌术后皮瓣坏死治疗中的应用体会

目的探讨负压封闭引流(VSD)技术在乳腺癌根治术后皮瓣坏死治疗过程中应用的疗效观察及优点。方法对56例实施乳腺癌改良根治术后发生皮瓣坏死的患者行清创后创面行聚乙烯酒精水化海藻盐泡沫敷料(VSD辅料)行负压封闭引流技术进行治疗。结果 52例经1次VSD治疗愈合,4例经2次治疗愈合。结论负压吸引技术是一种新的治疗乳腺癌术后皮瓣坏死的技术方法,效果显著,疗效确切,值得临床推广使用。     

Locomotor hyperactivity caused by dopamine infusion into the nucleus accumbens of rat brain: specificity of action

Rats selected as high-activity and low-activity responders to the hyperactivity-inducing action of peripherally administered (-)N-n-propylnorapomorphine [(-)NPA] were subject to intra-accumbens infusion of dopamine, noradrenaline, serotonin, acetylcholine and GABA (0.48 l/h, 25 g/24 h, 13 days). Locomotor activity was measured during infusion and for a minimum of 35 days thereafter. After discontinuation of infusion the animals' responsiveness to (-)NPA was also assessed and, on the 2nd day of withdrawal, sensitivity to the hyperactivity-inducing action of acute intra-accumbens dopamine was determined. Dopamine caused a biphasic pattern of hyperactivity during infusion with peaks of responding between days 2–5 and 8–12: normal values returned after withdrawal of infusion. However, 2–3 weeks after withdrawal of intra-accumbens dopamine infusion animals showed reversed responding to (-)NPA challenge, the initial low-active animals giving a high-active response and high-active animals giving low-activity. Infusions of noradrenaline, serotonin, GABA and acetylcholine produced some increase in locomotor activity towards the termination of infusion, but no treatment could replicate the first hyperactivity peak and no treatment, after withdrawal, could reverse the responsiveness to (-)NPA of high- and low-active animals. Acute injections of dopamine into the nucleus accumbens showed that the infusion of the different neurotransmitter substances caused change within that nucleus. Nevertheless, changes in locomotor behaviour following the infusion of dopamine into the nucleus accumbens are specific for dopamine.     

静脉滴注头孢哌酮钠舒巴坦钠致输液反应1例

1例60岁女性患者,因上呼吸道感染静脉滴注0．9％氯化钠加头孢哌酮钠舒巴坦钠3．0g,静脉滴注结束后1h出现寒战、发热、呼吸困难,经给予及时对症处置20min后症状逐渐缓解。次日再次输入同样药物,未再出现上述症状。     

Autophagy-inducing effect of pterostilbene: A prospective therapeutic/preventive option for skin diseases

Pterostilbene is a naturally occurring analog of resveratrol with many health benefits. These health benefits are associated with its antioxidant activity, anti-inflammatory effects, and chemopreventive effects attributed to its unique structure. The skin cancer chemopreventive potential of pterostilbene is supported by a variety of mechanistic studies confirming the anti-inflammatory effects in skin cancer models. Molecular biological studies have identified that pterostilbene targets pleotropic signaling pathways, including those involved in mitogenesis, cell cycle regulation, and apoptosis. Recently, pterostilbene has been reported to induce autophagy in cancer and normal cells. Through autophagy induction, the inflammatory-related skin diseases can be attenuated. This finding suggests the potential use of pterostilbene in the treatment and prevention of skin disorders via alleviating inflammatory responses by autophagy induction. This review summarizes the protective and therapeutic benefits of pterostilbene in skin diseases from the viewpoint of its antioxidant, anti-inflammatory, and autophagy-inducing effects. Novel underlying mechanisms regarding these effects are discussed. We proposed that pterostilbene, a promising natural product, can be used as a preventive and therapeutic agent for inflammation-related skin disorders through induction of autophagy.     

A simple formula for individualising ceftazidime dosage administered by continuous infusion in patients with haematological malignancies

A formula is proposed for individualising ceftazidime dosage administered by continuous infusion in patients with haematological malignancies. Sixty patients were retrospectively randomised into Group A (n = 30) to establish the formula and Group B (n = 30) to evaluate this formula. Individual ceftazidime clearances were estimated from the ratio between the rate of infusion and plasma concentration at steady state. In Group A, ceftazidime clearance was significantly correlated with creatinine clearance. From this result, a formula (rate of infusion (g/day) = 0.00133 × [creatinine clearance (mL/min)] × [target concentration at steady state (mg/L)]) is proposed. This formula provided consistent estimations of ceftazidime plasma concentrations in Group B and should help clinicians to define the optimum ceftazidime dosage, particularly in patients with disturbed renal function.