结节性多动脉炎与显微镜下型多血管炎的研究进展

1852年Rokitansky首次描述多血管炎,1866年Kussmaul根据病理特点进一步将其命名为结节性多动脉炎(polyarteritis nodosa,PAN),其特点为血管炎主要侵犯中等动脉,多累及肾脏和心脏,肾脏受累表现为肾梗死,又称之为经典型PAN.     

结节性多动脉炎与显微镜下型多血管炎的研究进展

18 5 2年Ｒｏｋｉｔａｎｓｋｙ首次描述多血管炎 ,186 6年Ｋｕｓｓｍａｕｌ根据病理特点进一步将其命名为结节性多动脉炎 (ｐｏｌｙａｒｔｅｒｉｔｉｓｎｏｄｏｓａ ,ＰＡＮ) ,其特点为血管炎主要侵犯中等动脉 ,多累及肾脏和心脏 ,肾脏受累表现为肾梗死 ,又称之为经典型ＰＡＮ。 194 8年Ｄａｖｓｏｎ等报道了一组以节段坏死性肾小球肾炎病理改变为特点的血管炎 ,并提出此病不同于经典型ＰＡＮ ,并将其命名为显微镜下型多血管炎 (ｍｉｃｒｏｓｃｏｐｉｃｐｏｌｙａｒｔｅｒｉｔｉｓｎｏ ｄｏｓａ ,ＭＰＡ)。许多情况下ＭＰＡ可能被诊断为ＰＡ…     

Concurrent polyarteritis nodosa and temporal arteritis

A patient is described in which features of both giant cell arteritis and polyarteritis nodosa were present simultaneously. The case emphasises our lack of an aetiologic classification for arteritis and that on occasions typical clinical presentations may be misleading.     

Acute streptococcal necrotising fasciitis

Two cases of acute streptococcal necrotising fasciitis are reported. Both patients were taking nonsteroidal antiinflammatory drugs when they developed this infection. Urgent surgical debridement was undertaken and resulted in a successful outcome in both patients. The clinical and histopathological features of this condition are reviewed.     

肛周外伤后合并肛周和背部坏死性筋膜炎1例

肛周坏死性筋膜炎低发病率, 高病死率, 是临床中较棘手的问题。组织感染是主要病因, 早期诊断、积极治疗是治疗本病的关键。对于大面积组织缺损的患者建议二期愈合, 术后抗感染治疗应升阶梯使用。手术仍是治疗本病的主要方式。     

Intravenous immunoglobulin as adjunctive treatment for streptococcal toxic shock syndrome associated with necrotizing fasciitis: case report and review

Streptococcal toxic shock syndrome (STSS) is caused by infection with a toxicogenic strain of Streptococcus pyogenes. Clinical manifestations may be those of a mild illness, characterized by malaise, fever, and muscle pain, to severe sepsis and multisystem organ failure. The syndrome may be associated with several invasive infections including necrotizing fasciitis. Treatment is primarily surgical debridement of infected tissue with supportive care, antibiotics, and hemodynamic monitoring. Intravenous immunoglobulin (IVIG) is reported to have beneficial effects in the management of STSS associated with necrotizing fasciitis. The agent was successful in conjunction with surgical excision and antibiotics in a patient with necrotizing fasciitis, toxic shock, and multisystem organ failure. On the basis of this experience and a thorough literature review, we concur that IVIG may be a useful adjunct in the treatment of STSS associated with necrotizing fasciitis.     

Diclofenac, paracetamol, and vidarabine removal during plasma exchange in polyarteritis nodosa patients.

Since plasma exchange (PE) represents a major treatment for patients suffering from systemic diseases, its influence on the kinetics of three drugs was investigated: vidarabine, used in patients with polyarteritis nodosa associated with hepatitis B virus (eight subjects), and diclofenac and paracetamol for investigative purposes (five subjects). This study confirmed that vidarabine is so rapidly deaminated to form hypoxanthine arabinoside (Hx-Ara) that no detectable concentrations were measured. Hx-Ara levels were used to evaluate vidarabine kinetics; 19.5 +/- 14.6 mg of Hx-Ara were removed by one PE during the first week of treatment (15 mg kg-1 d-1, continuous infusion) and 7.8 +/- 10.2 mg were eliminated by one PE during the second week of treatment (7.5 mg kg-1 d-1, continuous infusion). Based on the vidarabine intake per hour and the resulting quantity of Hx-Ara removed per hour, PE recovery was quite important (ca. 30 per cent), during both the first and second weeks of continuous infusion. Data were subject to large interindividual variability. However, these results do not favor vidarabine dosage supplementation in this indication because the duration of PE is less than 8 per cent of a daily administration period. For paracetamol (1 g, single oral dose) and diclofenac (100 mg, single oral dose), the fractions of drug removed during PE effected within 2 h of drug intake, were respectively 5.0 +/- 3.1 per cent and 13.6 +/- 9.5 per cent, while plasmapheretic clearance reached, respectively, 13.0 +/- 10.7 per cent of the systemic clearance for paracetamol and 23.0 +/- 1.0 per cent for diclofenac.     

A successfully treated case of severe necrotizing fasciitis caused by acute appendicitis: a case report

We successfully saved a patient with appendicitis followed by necrotizing fascitis. A 77-year-old man with a history of ambulatory treatment for depression underwent an emergency operation because of severe abdominal pain. Laparotomy demonstrated that necrotizing appendicitis was massively extending over the abdominal cavity, involving the right paracolic sulcus and Douglas pouch and posterior surface of the right kidney. Irrespective of the emergency surgery, redness and swelling in the right chest and abdomen, which was noted at the time of admission, was not decreased. Successively, a retension incision was performed under the diagnosis of necrotizing fasciitis. Necrotizing fasciitis is an extremely rare complication of appendicitis, and there were only 10 cases documented. Once necrotizing fasciitis occurs, the mortality rate is high, so that correct diagnosis and prompt debridement are mandatory. Particularly for elderly patients with appendicitis, rapid and accurate diagnosis and treatment are required.     

1例临床药师优化坏死性筋膜炎患者抗感染治疗方案的药学实践

临床药师参与1例罕见坏死性筋膜炎危重症患者的救治过程,运用药学知识结合患者病情,选择合适抗感染药物治疗方案。患者初始抗感染方案为利奈唑胺联合亚胺培南,后加用青霉素,在获取病原学结果后,针对泛耐药鲍曼不动杆菌感染,结合细菌敏感性试验,多次调整抗感染方案,确定以多黏菌素B联合舒巴坦复合制剂为基础的联合用药方案,患者临床症状及感染指标逐渐好转。临床药师参与临床药物治疗,对危重症患者展开药学服务,对少见疾病的治疗方案制定个体化给药方案,最大程度减少药物的不良反应,确保临床治疗安全、有效。     

Cutaneous abscess after Conus textile sting

We present a 31-year-old man who, after a Conus textile sting acquired in New Caledonia, developed a cutaneous abscess on a buttock. The abscess was accompanied by pain, paraesthesia, general malaise, and fever. Complete remission was achieved by sodium hypochlorite packs and oral amoxicillin/clavulanic acid, metronidazole, and tramadol.     

Changes of pharmacokinetics of trimethoprim after pretreatment with streptococcal peptidoglycan

Trimethoprim (TMP) 10 mg.kg-1 was given orally to calves and rabbits. Two to three weeks later the animals were pretreated by i.v. Peptidoglycan (Pt) 20 micrograms.kg-1. One hour later TMP was administered as above. To other animals under otherwise identical conditions TMP was injected intravenously. The pretreatment with Peptidoglycan induced in both species a significant increase of TMP serum levels positively correlated with temperature elevation. Peptidoglycan pretreatment increased the bioavailability of TMP.     

Cutaneous siderosis after intramuscular iron injections: a case report

Skin reactions against injected or implanted foreign materials are not rare. Siderosis is a disease characterized by the accumulation of iron in various tissues. Brownish-gray discoloration of the skin can be seen as a side-effect on the injection area after the parenteral iron treatment. Here, we present cutaneous siderosis case developed after multiple intramuscular iron injection on the gluteal region for iron-deficiency anemia. Development of cutaneous siderosis after intramuscular iron injection rarely has been reported in the literature before.     

Cutaneous metabolism of isosorbide dinitrate after transdermal administration in isolated perfused porcine skin

The purpose of this study was to determine whether isosorbide dinitrate (ISDN) was metabolized by the skin during transdermal delivery. In order to assess this, the isolated perfused porcine skin flap (IPPSF) was utilized since this in vitro model possesses a viable epidermis and intact vasculature, two attributes ideal for studying the biotransformation of a vasoactive drug. ISDN transdermal systems (20 cm²) were applied onto IPPSFs and the venous efflux sampled repeatedly over 16 h. ISDN, isosorbide-2-mononitrate (IS-2-MN), and isosorbide-5-mononitrate (IS-5-MN) fluxes were determined using gas chromatography. Approximately 14% of parent ISDN was metabolized to IS-2-MN and 10% to IS-5-MN. These observations are important as they indicate that a fraction of ISDN is biotransformed during transdermal delivery.     

Inhibition of streptokinase-induced, antibody-mediated platelet aggregation with tirofiban after exposure to streptokinase or streptococcal infection

STUDY OBJECTIVE: To evaluate the effect of tirofiban (a glycoprotein IIb-IIIa inhibitor) in preventing streptokinase-induced, antibody-mediated platelet aggregation after administration of streptokinase or development of a streptococcal infection. DESIGN: Prospective analysis. SETTING: Research center of a Canadian hospital. PARTICIPANTS: Forty-five healthy volunteers, 45 patients who had received streptokinase within the past 3 years, and 13 patients who had a severe streptococcal infection also within the past 3 years. INTERVENTION: Blood samples were drawn to measure the extent of inhibition of streptokinase-induced, antibody-mediated platelet activation and aggregation by tirofiban. MEASUREMENTS AND MAIN RESULTS: Platelet aggregation was measured by using a turbidimetric method. The extent of inhibition by tirofiban was measured by incubating tirofiban for 2 minutes before adding streptokinase 5000 U/ml. Also, tirofiban was added 2 minutes before adding adenosine 5'-diphosphate (ADP) 2 microM/L into the last tube as a comparison. Strepto-kinase-induced, antibody-mediated platelet aggregation was observed in 10 (22%) of the 45 patients treated with streptokinase, in 3 (23%) of the 13 patients with streptococcal infection, and in none of the 45 healthy volunteers. Tirofiban inhibited streptokinase-induced, antibody-mediated platelet aggregation by 89 +/- 14% (p<0.001). Similarly, ADP-induced platelet aggregation was inhibited by 92 +/- 6% (p<0.001) with tirofiban. CONCLUSION: Streptokinase-induced, antibody-mediated platelet aggregation occurred in 13 (22%) of 58 patients who received streptokinase or were exposed to a streptococcal infection in the past 3 years. Such patients may not benefit from streptokinase therapy. In these patients, tirofiban significantly decreased the extent of antistreptokinase antibody-mediated platelet aggregation. Hence, patients undergoing streptokinase therapy may benefit from tirofiban as adjunctive therapy.