华法林致皮下血肿1例

1病例资料 患者，女，61岁。因“活动后呼吸困难40天，伴右背部肿痛2天”于2007年9月8日入院。33年前因“淋巴结核”行右锁骨下淋巴结结核摘除术；高血压病史5年余，未正规用药。患者于40天前无明显诱因突然出现呼吸困难，以活动时明显，静卧减轻，当时无咳嗽、咳痰，无胸痛、咯血，无意识障碍，无发冷、发热，无非对称性下肢水肿。     

华法林致脑出血二例

例 1　患者男性 ,39岁 ,2 0 0 1年 6月 2 7日突感头痛 ,恶心、呕吐 ,次日急诊入院。既往因“先天性心脏病 ,室间隔缺损 ,二尖瓣关闭不全”于 1997年 6月行“室间隔修补术及二尖瓣置换术” ,术后坚持服华法林 ,在我院门诊随访监测凝血酶原时间 (ＰＴ)、国际标准化比值 (ＩＮＲ)半年左右 ,使ＩＮＲ在2～ 3范围。近 8个月每天服华法林 4 5ｍｇ ,一直未测ＩＮＲ。偶见牙龈出血 ,量少 ,能自行停止。查体 :神志清 ,体温36 3℃ ,血压 130 / 85ｍｍＨｇ(1ｍｍＨｇ =0 133ｋＰａ)。双侧瞳孔等大等圆 ,眼球运动灵活 ,颈部抵抗。心率 88次 /ｍｉｎ ,…     

华法林导致老年气管支气管弥漫性钙化1例并文献复习

目的 报道1例长期口服华法林导致弥漫性气管支气管钙化的病例,结合相关文献复习对华法林导致气管支气管钙化的病例特点、作用机制以及新型抗凝药物的替代进行阐述。方法 以“tracheobronchial calcification,warfarin”为检索词,在PubMed数据库检索2021年8月之前所有报道,共8篇文献,成年患者以个案报道的3例以及有关华法林导致气管支气管钙化病例对照研究1篇;在万方数据库以“气管支气管(弥漫性)钙化、华法林”为检索词,检索2021年8月之前所有报道的国内病例,检索到相关文献1篇;在中国知网数据库以“气管支气管(弥漫性)钙化、华法林”为检索词,检索到相关文献1篇。结果 本文报道1例77岁老年女性患者,口服华法林20年,胸部CT检查示气管、支气管弥漫性钙化,支气管镜显示气管和支气管无结节样凸起。气管支气管钙化在老年患者中较常见,成年患者中由华法林导致的气管支气管弥漫性钙化较少见,女性居多,无特殊临床和影像学特点。结论 长期口服华法林可导致气管支气管弥漫性钙化,目前因无明显临床症状未受重视,所以低估了该疾病的患病率,日后需加强临床及放射科医生对此类患者的肺部影像...     

华法林小册子

都说华法林是一种很难处理的药物。有多难？难到可以出一本小册子了。美国联邦医疗服务研究及质控署出版了一本关于华法林的小册子，给服用华法林的患者提供一些建议，包括服用这种药物会出现哪些状况，需要注意哪些情况，怎样确保安全。     

药物增强华法林抗凝作用5例

近年来采用华法林长期抗凝治疗的患者日益增多〔1〕,因此临床上常见同时并用其他药物后增强或降低华法林抗凝作用,导致患者血液中国际标准化比值(INR)变化的现象,本文将近年来我们遇见的并用其他药物后使华法林抗凝作用增强的5例患者情况报告如下。1临床资料例1男,78岁,因患高血压、持久性心房颤动、脑栓塞,口服华法林2·5mg,qd,INR维持在1·6~1·8。2005年1月12日因腹泻自服诺氟沙星0·2g,tid,7d后查INR升至5·78,未见出血征象,即嘱停服诺氟沙星及华法林,并肌内注射维生素K110mg,次日查INR继续升高达6·54,再静脉注射维生素K110mg,第…     

华法林钠合用苯溴马隆致皮肤、牙龈出血一例

患者男性 ,6 3岁。因皮肤、牙龈出血 2ｄ于 2 0 0 2年 9月 2 7日入院。患者于 2 0 0 0年 4月因风湿性心脏病合并瓣膜病变行主动脉瓣、二尖瓣人工瓣膜置换术 ,术后每天服用华法林钠 2 2 5ｍｇ ,监测国际标准化比率 (ＩＮＲ)在 2～ 3之间 ,无出血并发症。 2 0 0 2年 9月患者体检发现有高脂血症、高尿酸血症 ,门诊予阿昔莫司 2 5 0ｍｇ每天 2次 ,苯溴马隆 5 0ｍｇ每天 1次 ,碳酸氢钠 5 0 0ｍｇ每天 3次 ,降血脂、降尿酸治疗。服药 3周后患者发现双下肢皮肤瘀斑 ,牙龈出血 ,查凝血相 :凝血酶原时间 (ＰＴ) 4 8 9ｓ、ＩＮＲ 6 1、活化凝血活酶…     

华法林过量致小肠黏膜下出血1例

华法林过量引起自发性小肠壁内血肿是抗凝过程中较为少见的并发症之一,其导致亚急性肠梗阻.患者可表现为腹痛、凝血功能明显异常,可同时伴随恶心、呕吐、贫血,在临床工作中易被误认为肠系膜血栓形成或外科急腹症而给以溶栓或外科手术治疗.     

华法林过量致严重腹腔内出血一例

患者男，51岁。因全身红斑脱屑、瘙痒1个月于2003年10月6日入院。既往有糖尿病病史3年，2000年6月因风湿性心脏病行主动脉瓣换瓣术。有磺胺类药物过敏史。     

华法林致消化道大出血1例

患者男,85岁。因“乏力思睡、虚弱多汗2天”于2009年5月18日入院。否认高血压、糖尿病、消化性溃疡病史。2002年头颅CT检查示多发腔隙性脑梗塞。2007年7月被诊断为慢性房颤,遵医嘱长期服用地高辛0.125mg/日、华法林2.5mg/日。服药期间无牙龈出血、鼻衄、黑便、皮肤瘀斑及出血点。     

Late-onset warfarin-induced skin necrosis: case report and review of the literature

Warfarin-induced skin necrosis is a rare complication of therapy with warfarin or other coumarin derivatives. When it occurs it usually appears 3 to 6 days after initiation of therapy and almost always between days 1 and 10. We report a case of late-onset (16 days after initiation of therapy) warfarin-induced skin necrosis and review the literature on this rarely reported variant of warfarin-induced skin necrosis. The skin lesion in our patient was not associated with either deficiency of protein C or resistance to activated protein C. Am. J. Hematol. 57:233–237, 1998. © 1998 Wiley-Liss, Inc.     

Warfarin-induced skin necrosis: a case report.

Warfarin-induced skin necrosis is an unusual complication of anticoagulation therapy associated with high morbidity. A patient is presented who had protein C deficiency and in whom this complication developed twice within a short time as a result of delayed diagnosis. Early recognition of this syndrome has important implications in the treatment of such patients and may reduce the severity of complications.     

Dermatomyositis and cutaneous necrosis: report of five cases

We report on five patients with dermatomyositis (DM) and cutaneous necrosis. Patients presented with classic DM skin eruptions, mild myositis, and a high incidence (4/5) of interstitial pneumonia. Cutaneous necrosis developed independently of steroid therapy, with the majority of lesions being cured following several months of sterilization treatment. In addition, one patient with accompanying cancer presented with multiple necrotic lesions. Topical treatment using gentiana violet against local infection was considered to have been essential in accelerating healing. Received: September 10, 1999 / Accepted: March 9, 2000     

Kimura病1例并文献复习

目的提高对少见疾病Kimura病的认识。方法分析广州医学院第一附属医院广州呼吸疾病研究所于2008年7月29日收治的1例Kimura病伴支气管扩张患者的临床和病理资料,并复习相关文献。结果患者,女,18岁,16年前接种卡介苗后反复咳嗽、咳痰、出现全身多发性包块,临床特征主要是血嗜酸性淋巴细胞增多、头颈部包块及淋巴结肿大和支气管扩张。颈部皮下肿物活检符合嗜酸性淋巴肉芽肿,对糖皮质激素治疗有效。结论Kimura病属于少见病,合并支气管扩张是首例报道。     

Kimura 病1例并文献复习

目的 提高对少见疾病Kimura病的认识.方法 分析广州医学院第一附属医院广州呼吸疾病研究所于2008年7月29日收治的1例Kimura病伴支气管扩张患者的临床和病理资料,并复习相关文献.结果 患者,女,18岁,16年前接种卡介苗后反复咳嗽、咳痰、出现全身多发性包块,临床特征主要是血嗜酸性淋巴细胞增多、头颈部包块及淋巴结肿大和支气管扩张.颈部皮下肿物活检符合嗜酸性淋巴肉芽肿,对糖皮质激素治疗有效.结论 Kimura病属于少见病,合并支气管扩张是首例报道.     

Primary cutaneous diffuse large B-cell lymphoma (leg type) after renal allograft: case report and review of the literature

We report a case of a 58-year-old man who presented with a rapidly growing proliferative lesion on the left lower limb, clinically resembling a soft tissue sarcoma 3 years after renal allograft. There was no evidence of systemic involvement on bone marrow needle aspiration and computed tomography (CT) scans of the chest and abdomen. The lesion turned out to be primary cutaneous diffuse large B-cell lymphoma, leg type (PCLBCL LT), as defined in the recent World Health Organization–European Organization for Research and Treatment of Cancer (WHO–EORTC) classification of cutaneous lymphomas by skin biopsy. Immunosuppression reduction, chemotherapy with CHOP regimen and local radiotherapy induced complete remission of the tumor.     

Black esophagus: a case series and literature review of acute esophageal necrosis

Black esophagus or acute esophageal necrosis (AEN) is a rare medical disorder which is characterized by a diffuse circumferential black esophageal mucosa. The majority of patients present with signs of upper gastrointestinal bleeding. Diagnosis is made based on esophagogastroduodenoscopy. Treatment consists of intravenous fluids, proton pomp inhibitors and additional therapies to treat the underlying illness. In this article we present five cases of patients with AEN and briefly review the literature of AEN.     

Multifocal avascular necrosis in a patient with refractory immune thrombocytopenia and antiphospholipid antibodies; case report and review of literature

Avascular necrosis (AVN) is a devastating condition that is rarely reported in patients with immune thrombocytopenia (ITP). Treatment with steroids remains a major risk factor for developing AVN. However, the incidence of AVN in patients with ITP requiring corticosteroid therapy is much less than that observed with other clinical conditions requiring corticosteroids. ITP is a bleeding disorder but can be also be a pro-thrombotic state via different mechanisms and thus could result in AVN. Among the possible causes of this pro-thrombotic state is the presence of antiphospholipid antibodies (aPLs). In this case, we report a patient with refractory ITP who developed multifocal AVN around the time she acquired new aPLs. We also discuss different mechanisms by which risk of thrombosis is increased in ITP and the relationship between ITP, aPLs and antiphospholipid syndrome.     

Cutaneous legionellosis: case report and review of the medical literature

Discrete nodules developed on the leg of a 27‐year‐old immunosuppressed woman after an allogeneic stem cell transplant. Biopsy and culture grew Legionella pneumophila serogroup 8. On day 7 of azithromycin treatment, respiratory distress and abnormal liver transaminases developed, and the patient died on day 14. Review of the medical literature identified 19 reports of Legionella species‐associated skin or soft tissue infections (total of 20 patients, 13 with confirmed infection). Manifestations of the 13 confirmed cases included erythematous macular rash (n = 7), erythema after thoracentesis (n = 1), abscess formation (n = 4), respiratory symptoms (n = 6), and abnormal chest radiographs (n = 8). Six required surgical exploration and débridement, and 7 were immunocompromised. Rash and respiratory infection improved with antibiotics in 10, but 3 died. Immunosuppression may predispose transplant recipients to Legionella infections. Diagnostic biopsies may facilitate appropriate treatment.     

Propylthiouracil-Induced severe hepatitis: A case report and review of the literature

A 21-year-old woman was diagnosed as having Graves' disease in April, 1995. Thiamazole was administered; about a month later the patient had a skin rash and propylthiouracil (PTU) was given instead. Two months after commencing PTU, she rapidly developed jaundice, accompanied by severe liver damage. The drug-induced lymphocyte stimulating test was positive for PTU and she was diagnosed as having severe hepatitis induced by PTU. After pulse therapy with 500 mg of methylprednisolone was given for 3 days, liver function test results were gradually improved, and became normalized 1? months after admission. The pathology findings of the liver biopsy sample taken before administration of corticosteroid showed necrosis of hepatocytes predominantly around the central veins (i.e., zone 3 necrosis), and moderate to severe infiltration of lymphocytes and neutrophils in portal areas and lobules. Severe hepatic damage due to PTU is rare; 25 cases have been reported so far in the English-language literature. When we use PTU for patients with hyperthyroidism, we should keep in mind that severe liver damage induced by PTU can be fatal, and we should therefore diagnose it earlier by liver biopsy and lymphocyte stimulating test. (Received Dec. 1, 1997; accepted Jan. 23, 1998)