Anticholinergic prophylaxis of acute haloperidol-induced acute dystonic reactions

Young adults treated with a high potency neuroleptic such as haloperidol are at high risk of developing dystonic reactions. In this retrospective study, 15 of 16 young adult patients treated only with haloperidol had such reactions within 60 hours of beginning the drug, while none of the seven patients treated with haloperidol plus prophylactic benztropine mesylate developed dystonia. Although methodologic considerations limit the generalization of these results, they are consistent with other reports and suggest that initial anticholinergic prophylaxis is warranted in young patients treated with high potency antipsychotics. All dystonic reactions in these patients occurred within 2 1/2 days, justifying the consideration of discontinuing prophylaxis (which also causes side effects) after 1 week.     

米卡芬净致急性溶血反应并肾衰竭

1例76岁男性患者因肺部感染给予米卡芬净50 mg加入0.9%氯化钠注射液100 ml静脉滴注,1次/d。首次用药后90 min,患者出现寒战、发热,尿色呈暗褐色。实验室检查：外周血白细胞计数25.2×10^9/L,血红蛋白73 g/L,血小板计数179×10^9/L,尿素氮6.4 mmol/L,肌酐96μmol/L,降钙素原14.13 ng/ml,凝血酶原时间17 s,活化部分凝血活酶时间44 s,D-二聚体8.7 mg/L;尿白细胞（＋＋＋）,隐血（＋＋＋）,尿胆原（＋＋＋）,酮体（＋＋＋）,尿蛋白（＋＋＋）,亚硝酸盐阳性。考虑为急性溶血反应。停用米卡芬净,静脉注射甲泼尼龙40 mg,并给予水化利尿和碱化尿液治疗。患者尿量在4 h内由100-150 ml/h减至10-20 ml/h,尿色呈酱油样。次日复查：白细胞计数18.6×10^9/L,红细胞计数1.7×10^12/L,血红蛋白57 g/L,血小板计数116×10^9/L,网织红细胞0.05;白蛋白25 g/L,间接胆红素20.4μmol/L,天冬氨酸转氨酶108 U/L,丙氨酸转氨酶42 U/L,尿素氮17.9 mmol/L,肌酐230μmol/L,直接抗人球蛋白试验阳性。考虑并发急性肾衰竭。给予积极抗感染治疗,同时行连续性肾脏替代性治疗、输注红细胞悬液、输注血浆。10 d后,患者仍处于无尿状态,黄疸进行性加重,家属放弃治疗。     

急性肾损伤诱导急性肺损伤的研究进展

急性肾损伤是一种ICU患者中常见的疾病,致死率较高,当合并肺损伤时,致死率显著提高,可达到80%。急性肾损伤可导致全身体液灌注量增加,血浆渗透压升高进而引起肺水肿和急性呼吸衰竭。同时,炎症反应,氧化应激,细胞凋亡和可溶性调节因子代谢异常等也可能参与急性肾损伤诱导的肺损伤。对急性肾损伤诱导肺损伤的临床认识和可能发病机制的研究,将有助于临床疾病的治疗和死亡率的降低,同时也将有助于对其它肾脏疾病发病机制的认识。     

成人急性荨麻疹与急性细菌性咽炎的关系

目的：了解急性荨麻疹发作与急性细菌性咽炎的关系。方法：选择观察组100例急性荨麻疹患者,对照组101例慢性荨麻疹患者,均进行全身体格检查及外周血全血细胞分类计数、咽拭子细菌培养,以观察荨麻疹发作与急性细菌性咽炎的关系。结果：治疗组中发现有27例有急性细菌性咽炎,而对照组中只发现有6例有急性细菌性咽炎,两组比较差异有统计学意义（χ2=14.742,P〈0.01）。结论：急性细菌性咽炎是急性荨麻疹发作的病因之一。     

Pharmacotherapy of acute lung injury and acute respiratory distress syndrome

Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) are characterized by rapid-onset respiratory failure following a variety of direct and indirect insults to the parenchyma or vasculature of the lungs. Mortality from ALI/ARDS is substantial, and current therapy primarily emphasizes mechanical ventilation and judicial fluid management plus standard treatment of the initiating insult and any known underlying disease. Current pharmacotherapy for ALI/ARDS is not optimal, and there is a significant need for more effective medicinal chemical agents for use in these severe and lethal lung injury syndromes. To facilitate future chemical-based drug discovery research on new agent development, this paper reviews present pharmacotherapy for ALI/ARDS in the context of biological and biochemical drug activities. The complex lung injury pathophysiology of ALI/ARDS offers an array of possible targets for drug therapy, including inflammation, cell and tissue injury, vascular dysfunction, surfactant dysfunction, and oxidant injury. Added targets for pharmacotherapy outside the lungs may also be present, since multiorgan or systemic pathology is common in ALI/ARDS. The biological and physiological complexity of ALI/ARDS requires the consideration of combined-agent treatments in addition to single-agent therapies. A number of pharmacologic agents have been studied individually in ALI/ARDS, with limited or minimal success in improving survival. However, many of these agents have complementary biological/biochemical activities with the potential for synergy or additivity in combination therapy as discussed in this article.     

Management of acute cholecystitis and acute cholangitis in emergency setting

Acute biliary infection (acute cholecystitis and acute cholangitis) is one of the common emergency conditions which carries significant morbidity and mortality. The risk factors are often associated with gallstones, biliary stasis and bile infection. Gram-negative bacteria are frequent isolates from bile and blood cultures in infectious cholangitis. Endotoxaemia from the gram-negative microbes results in circulatory shock and organ dysfunction. Therefore, prompt diagnosis with severity stratification and recognition of its potential rapid progression to life-threatening shock and multi-organ failure ensure execution of the three fundamental interventions in the initial management strategy, namely: resuscitation to support the organ, antimicrobial therapy and biliary decompression drainage to control the infection. This is the core principle in the management of severe acute cholangitis.     

Antimicrobial-associated acute hepatitis

Recently, the case history of a 44-year-old woman who experienced acute hepatitis subsequent to therapy for chronic sinusitis was reviewed. The patient sequentially was administered clarithromycin, levofloxacin, amoxicillin-clavulanate, and gatifloxacin. Her adverse events were attributed definitively to gatifloxacin, a surprising conclusion because many other possible causes of hepatitis existed in this case. Not ruled out as potential causes of the clinical and laboratory adverse events were hepatitis other than hepatitis A or B. Other antimicrobials administered were dismissed. In particular, extended treatment with amoxicillin-clavulanate has been clearly linked to hepatotoxic effects that may occur long after therapy begins. Thus, while we agree that physicians must be aware of the potential for antimicrobial hepatotoxicity, we believe that this case study is not a solidly documented case of hepatitis attributable to gatifloxacin and overlooks other possible causes of acute hepatitis of which prescribers should be aware.     

Drug-induced acute pancreatitis

The incidence of acute pancreatitis appears to have increased in the USA, Denmark and in the United Kingdom and one suggested explanatory factor is a simultaneously increased use of certain drugs. This report surveys the available information on the association between drugs and acute pancreatitis in the literature and in spontaneous reporting systems in Denmark, Sweden and in the United Kingdom, supplemented with information from the WHO data base. Apart from one case-control study which provided evidence for an association between diuretic use and acute pancreatitis, the information in the literature is based on single case reports. About 15 drugs are frequently reported both in literature, and in spontaneous reporting systems, to be associated with pancreatitis and can be regarded as adverse reaction signals. The validity of such data is often low and does not provide information on relative or absolute risks, if any, for a drug adverse reaction association. To elucidate the possible role of drugs in etiology of acute pancreatitis, further formal epidemiologic studies are needed.     

急性闭角型青光眼双眼急性发作的诱因分析

目的对急性闭角型青光眼双眼急性发作的诱因进行分析以减少其发作。方法选取2008年6月～2011年6月本院收治的急性闭角型青光眼双眼急性发作的患者25例,立即对其进行降低眼内压治疗,待眼内压得到控制之后,进行滤过性手术的患者10例,进行虹膜激光透切术的患者15例。手术后进行双眼的前房深度测量以及周边前房深度测量,并测量双眼深度差,以及屈光状态。结果经数据整理,各诱因组之间P值均大于0.05,提示经治疗后,不同诱因的治愈率差异无统计学意义。结论疼痛的刺激、情绪的剧烈波动和M受体阻断剂等药物使瞳孔扩散增大,是此类疾病的最常见诱因,临床治疗护理工作中应引起足够重视。     

Painless, acute aortic dissection presenting as an acute stroke

Acute aortic dissection is an uncommon disease; however, it has a high mortality rate. Classically, aortic dissection presents with sudden and severe pain in the chest, back, or abdomen. Patients often describe tearing or ripping pain. There are a few reports of atypical findings or no pain in the literature. We report a case of painless, acute aortic dissection presenting as acute stroke.     

Mefloquine-induced acute hepatitis

Mefloquine is an effective drug for prophylaxis and treatment of malaria caused by Plasmodium falciparum. It is generally well tolerated with few side effects. Minimal elevation of liver function tests has been reported after exposure to mefloquine, especially in susceptible individuals with prior abnormal liver function tests. Our patient, who had had elevated liver function tests attributed to heart failure, experienced an acute elevation of liver transaminases 6 weeks after exposure to mefloquine 250 mg/week. Cessation of the drug caused test results to return to normal. Mefloquine should be prescribed cautiously in patients with liver disease.     

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(-)、…     

左氧氟沙星致急性粒细胞缺乏

患者男,21岁,因劳力性胸闷、心悸、气促3个月,于2006年7月28日入院。患者于3月前出现胸闷、心悸、气促,活动时明显,休息后缓解;伴发热、干咳,T38℃,热     

Ueber acute Eisenwirkung

Ohne Zusammenfassung     

左旋咪唑引起急性黄疸性肝炎

患者男,13岁。因全身皮肤、巩膜黄染14d,于2005年1月24日入院。患者于1月10日因恶心、呕吐、腹痛在当地卫生院诊断为“肠道蛔虫症”,给予左旋咪唑300mg,当晚及次晨各服150mg。1月14日出现全身皮肤黏膜黄染,尿色发黄,在当地医院查外周血WBC12.7×109/L,Hb119g/L,BPC252×109/L,ALT475U/L,T-Bil486.2μmol/L,D-Bil305.6μmol/L。B超示腹腔积液,肝胆脾胰腺均未见异常。按肝炎予护肝、抗感染等治疗效果差,转入我院。入院查体:T37.1℃,营养稍差,全身皮肤黏膜黄染,浅表淋巴结不大,咽无充血,胸骨无压痛,心肺听诊正常;腹平软,全腹有轻度压…