口服氢氯噻嗪致寒战高热1例

【病例】　男,36y。反复腹胀、双下肢水肿5a,伴精神障碍2h,1998年5月10日入院。曾多次住我院均诊断为慢性酒精中毒性肝硬化,肝功能失代偿期。入院查体:t36.2℃,面色灰暗,色素沉着,神志恍惚,谵忘,心肺正常,腹壁静脉上行性曲张,肝脾未触及,腹水征( ),双下肢中度凹陷性水肿。肝功能:总胆红素20.3μmol/L,直接胆红素9.8μmol/L,血浆总蛋白58g/L,白蛋白26g/L,球蛋白32g/L,血清酶ALT16IU/L,AST32IU/L。血氨95mg/L。诊断:肝硬化腹水;肝性脑病。给保肝及谷氨酸钠ivgtt治疗后,当日神志清醒。于次日因服氢氯噻嗪片(广东石岐制药厂,批号980374)…     

腺苷蛋氨酸治疗慢性酒精性肝病合并重度肝内胆汁瘀积的评估

慢性酒精性肝病是由于长期饮酒造成的常见肝脏疾病。本文采用随机对照方法，前瞻性地观察腺苷蛋氨酸在慢性酒精性肝病合并严重肝内胆汁瘀积的治疗作用，以寻求新的有效的治疗方法。材料和方法收集1997年～1999年我院住院病人，慢性酒精性肝病组共11例，男10例，女1例，平均年龄46岁。必须符合以下的诊断标准：（1）有5年以上长期的饮酒史（男性＞120g／天，女性＞80g／天）。（2）血清总胆红素＞320mol／L，血清直接胆红素＞100mol／L。（3）五种病毒性肝炎的血清学指标均阴性，近期内无诱发肝损害的药物史。（4）B超和／或CT排除肝内外梗…     

头孢氨苄致急性药物性肝炎

患者男,30岁。因发热2d,于2005年3月26日入院。入院前2d在院外诊所就诊,化验检查:血常规WBC9.3×109/L,N0.912,疑为存在感染,给予头孢氨苄500mg口服,4h后出现全身皮肤广泛红斑,伴皮肤瘙痒、乏力、尿黄如浓茶、灰白便。无慢性肝病、饮酒及输血史。查体发现皮肤巩膜明显黄染,未见肝掌及蜘蛛痣,肝脾肋下均未触及,莫氏征(-),肝区无叩痛。肝功能:ALT165U/L,AST53U/L,T-Bil116μmol/L,D-Bil86.1μmol/L,ALP190U/L,GGT317U/L,TBA215μmol/L,CHE5910U/L,LDH177U/L,TP67g/L,ALB45g/L,凝血酶原活动度97%。HBsAg(-)、抗HBs(-)、…     

干扰素致垂体性甲状腺功能减退

患者女,42岁。因食欲不振,反复乏力,腹胀,肝区不适3个月,于2002年6月22日就诊。患者于4年前因病输血200ml,既往无甲状腺疾病史,无产后大出血史,家族中无遗传病及自身免疫性疾病。查体:全身皮肤黏膜无黄染,无慢性肝病体征,双侧甲状腺正常,未扪及结节,无血管杂音,肝睥不大。实验室检查:ALT194U/L,AST173U/L,白蛋白51g/L,球蛋白28g/L,总胆红素,直接和间接胆红素均正常。甲,乙,戊型肝炎病毒血清标记物均阴性,荧光酶联免疫(PCR)法测HBV DNA阴性,抗HCV阳性,HCV RNA阳性。B超提示慢性肝病。临床诊断:慢性丙型肝炎。2002年8月开始干扰…     

慢性肝病患者肝纤维化血清学指标与肝组织纤维化分期的量化关系

目的研究肝纤维化血清学指标与慢性肝病患者穿刺活体组织学检查纤维化分期的量化关系。方法用放射免疫法检测118例肝病患者血清层黏连蛋白(LN)、透明质酸(HA)、Ⅲ型前胶原蛋白(PCⅢ)、Ⅳ型胶原蛋白(CⅣ)的水平,并与患者的肝组织病理学检查作对比。通过SPSS11.0软件包分析LN、HA、PCⅢ、CⅣ与肝组织纤维化分期及炎症分级的量化关系。结果LN、HA、PCⅢ、CⅣ与肝组织学炎症分级有正相关性(r值分别为0.394、0.449、0.443、0.315,P值均<0.01)。LN、HA、PCⅢ、CⅣ对S2以上肝纤维化诊断界值分别为110、110、100、70μg/L,诊断灵敏度分别为70%、79%、79%、74%,特异度分别为68%、72%、64%、73%。对S4(早期肝硬化)的诊断价值分别为130、140、120、70μg/L,其诊断灵敏度分别为79%、93%、79%、86%,特异度分别为66%、82%、72%、61%。受试者工作特征曲线分析显示:在这些患者中判断有无肝硬化存在,HA比其他指标更有价值;HA测定值>190μg/L时,其诊断早期肝硬化的准确度为93%。结论慢性肝病患者、血清肝病患者,血清LN、HA、PCⅢ、CⅣ水平与肝纤维化分期有一定量化关系,其中HA诊断早期肝硬化有重要意义。     

肝病伴糖代谢异常患者的临床治疗探析

目的通过分析研究肝病伴糖代谢异常患者的治疗效果,总结出最佳临床治疗方法,以此来提高疗效。方法选取自2009年6月至2011年8月入住本院治疗的慢性肝病患者400例,采取肝病伴糖代谢异常诊断标准选取100例患者,回顾临床资料进行调查研究。结果 400例患者中,肝硬化280例,慢性乙型肝炎120例;52例肝硬化伴肝源性DM,占18.6%,43例肝硬化伴肝源性LGT,占15.4%,3例慢性乙型肝炎伴肝源性DM,占2.5%,2例慢性乙型肝炎伴肝源性LGT,占1.7%。治疗后,5例慢性乙型肝炎伴糖代谢异常患者肝功能基本恢复,95例肝硬化伴糖代谢异常患者,84例患者肝功无显著变化,11例因并发症而发生死亡。结论临床上采用纠正血糖水平等方法对原发性肝病进行治疗,同时也要对诊断出的肝源性糖代谢异常患者进行及时治疗,以此促进原发性肝病的治疗与恢复,对提高临床治疗水平与患者生命质量有很大帮助。     

金刚藤胶囊及丹莪妇康煎膏致重症肝炎

1例34岁女性因慢性盆腔炎服用0.5 g金刚藤胶囊4粒,3次/d;丹莪妇康煎膏10 g,2次/d.患者既往无药物过敏史及慢性肝病史.治疗17 d后患者出现皮肤巩膜黄染、恶心、呕吐、腹胀、纳差.肝功能:ALT828 U/L,AST 768 U/L,TBil 222.1μmol/L,DBil 100.8 μmol/L,TBA 283.0 μmol/L.入院后患者黄疸持续,TBil最高达273.4μmol/L,PTA 45.6%,INR 1.63,肝穿刺病理检查提示肝小叶片状坏死,汇管区重度碎屑状坏死及桥接坏死,诊为重症药物性肝炎.停用两种药物,给予保肝和支持治疗,以及血浆置换治疗.入院12周后实验室检查示:ALT 49 U/L,AST 47 U/L,TBil 52.0μmol/L,DBil 44.3μmol/L和TBA 37.9μmol/L.出院3个月后肝功能恢复正常.     

碘普罗胺致急性肾衰竭

1例65岁男性2型糖尿病患者,因反应迟钝伴口齿不清入院。头颅磁共振成像示脑梗死(急性期),给予肠溶阿司匹林(0.1g,1次/d)、依达拉奉(30mg,1次/d)及甲钴胺等药物治疗。因胸部、腹部CT增强扫描,连续2d各使用造影剂碘普罗胺100ml(含碘30g),第3天出现双下肢水肿,尿量400ml/24h,随后无尿,静脉给予呋塞米未见好转。复查血肌酐475μmol/L,尿素氮24.5mmol/L。诊断为急性肾衰竭,考虑与碘普罗胺有关。连续血液透析治疗5d后,患者尿量增加,血肌酐降至284μmol/L。17d后血肌酐231μmol/L,尿素氮14.4mmol/L。患者双下肢水肿明显好转,出院。     

脑型肝豆状核变性CT表现及与临床的关系

肝豆状核变性为常染色体隐性遗传性慢性进行性多系统疾病,主要累及脑、肝、角膜、肾等组织。临床可分为症状前期、脑、肝病三型。本文报导11例经临床及生化检查证实的脑型肝豆状核变性患者CT与临床资料并加以分析,提示CT有助于临床诊断。     

静脉滴注甘油致急性溶血肾功能衰竭1例

患者,男,48岁。以头痛伴右侧肢体无力10小时入院。既往高血压病史3年。无药物过敏及肾肝疾病史。根据临床症征及CT诊断为脑出血。治疗给6-氨基已酸止血、青霉素预防感染、脱水用10％甘油500ml,每12小时静脉滴注一次。第二天用10％甘油后突然出现胸闷、腹痛、腰痛、排出酱油色尿120ml,腹泻大便呈咖啡色稀便,继之少尿,每日尿量不足200ml。实验室检查:血红蛋白100g/g,白细胞12.0×10~9/L,红细胞2.5×10~(12)/L,尿pH9.0,尿蛋白3g/L,尿胆原280.7μmol/L,尿素氮50.3mmol/L,血清胆红素85.1μmol/L,间接胆红素75.3μmol/     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.