骨肽注射液致变态反应2例

例1,男,60岁。2005年1月4日因左足痛1h入院。诊断:左外踝骨折。体检:血压110/70mmHg(1mmHg=0.133kPa),左外踝处肿胀青紫、压痛,给予骨肽注射液(山西恒大制药有限公司生产,批号:20040218)6mL,加入5%葡萄糖注射液250mL,静脉滴注,在滴注2min时患者突感胸闷憋气,有濒死感。体检:血压90/60mmHg,口唇轻度发绀,呼吸急促,约30次·min-1,双肺闻及大量哮鸣音,心率96次·min-1。立即停用骨肽注射液,给予地塞米松10mg,iv,异丙嗪25mg,im,并予吸氧,约20min后症状消失。后停用骨肽注射液,未再出现上述反应。例2,女,50岁。2004年11月21日因右锁骨骨折住院…     

依达拉奉注射液致心律失常

1名69岁女性因后循环缺血入院,给予依达拉奉30mg,2次/d静脉滴注。患者在上午首次滴注后出现心慌、胸闷,下午再次滴注后症状加重,BP130/70mmHg,HR70次/min,期前收缩2～3次/min。24h动态心电图显示:窦性心律不齐、频发性室性期前收缩、短阵室性心动过速。停止使用依达拉奉,并口服胺碘酮0.2g,3次/d。12d后症状消失,复查心电图显示正常。     

骨肽注射液致不良反应1例

患者,女,50岁。因“车祸时左下胸部撞击前排座位,即感左上腹疼痛,呈持续胀痛4h”于2006年1月17日入院。查体:体温36℃,血压120/60mmHg,心率70次min-1,呼吸18次min-1,神志清楚,急性痛苦病容,左下胸廓压痛明显,第五~九肋骨可见异常活动、可触及骨擦感。胸部正侧位X光片提示:左侧第五~九肋骨骨折。给予骨肽注射液(湖北黄石市生物制药厂生产,批号20041101)4mL加入5%葡萄糖注射液250mL静滴,1日1次,在滴注10min时患者突发寒战、高热,伴头晕,恶心、呕吐,呼吸急促。查体:体温达40.4℃,血压97/60mmHg,心率117次min-1,呼吸30次min-1,神志清楚,心肺听…     

降钙素致不良反应

患者女,83岁,因骨质疏松,剧烈骨痛于2002年4月12日起使用阿法骨化醇0.5μg,qd po,降钙素(密钙息)50u,每周2次,肌注。由于肌注降钙素3次后症状改变不明显,遵医嘱于4月23日将降钙素改为100u,肌注。于第4次注射约0.5h后出现寒战,恶心、呕吐,血压升高至195/96mmHg(基础血压110/70mmHg),心动过速,HR120次·min~(-1),体温正常。立即与医生联系,给予硝苯地平10mg,阿替洛尔12.5mg,维生素B_620mg,艾司唑仑2mg po。1h后症状明显好转。查体:BP 110/76mmHg,HR 78次·min~(-1),第2大患者症状完全恢复。以后继续使用密钙息50u,每周2次肌注治疗,未再发生不良反应。     

注射用生长抑素致过敏性休克

1例51岁男性乙型肝炎肝硬化失代偿期患者因上消化道出血给予静脉滴注生长抑素3 mg持续12 h;兰索拉唑30 mg,1次/12 h;维生素K110 mg,1次/d。维生素K1和兰索拉唑于2 h输注完毕,患者未出现不适。生长抑素滴注约2.5 h时,患者出现寒颤,呼吸困难,立即停用生长抑素。约10 min后患者出现神志不清、呼之不应,心率160次/min,呼吸32次/min,血压测不到。予面罩吸氧,地塞米松10 mg静脉注射,肾上腺素1 mg皮下注射,异丙嗪25 mg肌内注射。约20 min后,患者逐渐清醒,但精神萎靡,表情淡漠。1.5 h 后,寒颤、呼吸困难消失,复查心率110次/min,呼吸23次/min,血压109/50 mmHg（1 mmHg＝0.133 kPa）。换用醋酸奥曲肽0.5 mg溶于0.9%氯化钠注射液60 ml,1次/12 h静脉泵入,兰索拉唑、维生素K1继续治疗,患者未再发生类似症状。     

单唾液酸四己糖神经节苷脂钠致严重过敏反应2例

2例患者静脉滴注单唾液酸四己糖神经节苷脂钠引致严重过敏反应。第1例为91岁男性帕金森病患者,静脉滴注单唾液酸四己糖神经节苷脂钠40mg,滴注10min后出现寒战、心悸、全身冷汗,BP由入院时的155/70mmHg降至130/60mmHg。第2例为84岁男性慢性肾功能衰竭合并脑缺血患者静脉滴注60mg,滴注结束后5min出现胸闷、心悸、头晕、寒战、四肢厥冷、全身冷汗、神志淡漠,BP由入院时的150/80mmHg降至90/60mmHg。2例患者经过抗过敏治疗和对症治疗后症状消失。停用该药后未再出现类似症状。     

碘克沙醇注射液致剧烈头痛和视物模糊

1例60岁女性冠心病患者,动脉注射碘克沙醇注射液约50 ml行冠状动脉造影.术后1 h患者出现头晕、恶心、剧烈头痛、视物模糊,BP 110/70 mmHg,头颅CT无异常.给予地塞米松、补液及对症治疗,7.5 h后症状完全缓解.     

西咪替丁引起休克2例

例 1 女 ,48 岁 。 因患 浅 表性 胃炎 入 院治 疗 。入 院 查体 : T 36℃, P 74 次 /min, BP 120/80 mmHg (1mmHg = 0.133 kPa),双肺呼吸音清晰, 未闻及湿啰音，ＨＲ 74 次 /min ,律齐 ,未闻及 病理性杂 音。给予西咪 替丁注射液 0.6g,2 次 /d 静脉 滴注 。首次 滴注 10 min 后 ,患 者出 现神志 模糊 ,大 汗淋 漓,唤 之不应。 查 体 BP 80/50 mmHg, P 50 次 /min, 压 眶反 射 存在 ,两 瞳 孔对 光 反射 灵 敏, HR 50 次 /min, 律 齐,无杂 音。 考虑 为过 敏性休 克, 立即 停止滴 注西 咪替 丁, 给予吸 氧, 异丙 嗪 25 mg 静脉 推注 ;…     

注射用骨瓜提取物致严重过敏反应1例

1例46岁男性患者因右股骨近端粉碎性骨折入院。给予注射用骨瓜提取物静脉滴注以促进骨折愈合。输液2min后出现头晕、心悸、恶心、呼吸困难。查体：脉搏细速,面色苍白,口唇紫绀,呼吸浅快。HR102次/min,BP：70/50mmHg。停液,吸氧,给予肾上腺素,地塞米松,同时加大补液量,15min后患者症状逐渐好转。     

紫杉醇所致过敏性休克患者再用紫杉醇1例报告

1例70岁女性患者,卵巢癌术后21d,给予紫杉醇210mg加入0.9%氯化钠注射液500ml静脉滴注化疗。5min后患者出现胸闷、全身针刺感,随后出现意识丧失,面色苍白,四肢湿冷,呼吸困难,BP80/62mmHg,HR100次/min。立即停用紫杉醇,给予地塞米松及盐酸异丙嗪,10min后症状缓解。之后,再次低浓度、慢速滴注紫杉醇,未再发生过敏反应。     

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.     

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.