Switch to icatibant in a patient affected by hereditary angioedema with high disease activity: a case report

Icatibant, an antagonist of the bradykinin B2 receptor, was approved for the treatment of acute attacks of hereditary angioedema in the EU in 2008. This paper presents the case of a 65-year-old woman affected by frequent acute attacks of hereditary angioedema who benefitted from a change of therapy to icatibant, following years of treatment with C1-inhibitor.     

1例卡泊芬净致低蛋白血症合并肺部真菌感染患者肝损伤报道

本文通过对1例低蛋白血症合并肺部真菌感染患者在抗真菌治疗过程中肝功能异常的原因分析及药学监护,探讨卡泊芬净在低蛋白血症患者中引起肝损伤的机制。卡泊芬净在低蛋白血症患者体内游离水平升高,导致肝脏内血药浓度上升,从而增加卡泊芬净致药物性肝损伤的风险。临床药师参与临床药物治疗有助于及时发现问题,优化药物治疗方案。     

Unusual high dose of tacrolimus in liver transplant patient, a case report

CASE: We describe the case of a liver transplant patient who had great difficulty in reaching the desired trough blood levels despite the use of high dose tacrolimus. The patient was homozygous for the CYP3A5*3 allele. However, the respective donor carried the wild-type CYP3A5*1/*1 genotype. Regarding ABCB1 SNPs at exon 21 and 26, the patient showed the 2677GT and 3435CC genotypes. For the corresponding donor we observed the 2677GG and 3435CC wild-type genotypes. One, two and three weeks after transplantation the patient received daily 0.219, 0.287 and 0.273 mg/kg of tacrolimus, respectively. However, the corresponding tacrolimus trough blood levels were of 4.6, 5.6 and 6.1 ng/mL. The tacrolimus target level of 10.4 ng/mL was finally reached after 1 month of therapy. During the entire period of observation the kidney showed no sign of damage. No other signs of toxicity were reported except for the occurrence of an isolated systolic hypertension. CONCLUSIONS: CYP3A5 genotyping may represent a useful tool to better evaluate the appropriate initial dose of tacrolimus for patients carrying a liver with the CYP3A5*1/*1 genotype.     

一例贲门癌患者服用阿帕替尼发生缺血性脑卒中的病例分析

目的通过1例药品不良反应探讨肿瘤临床药师在保障患者服用口服靶向抗肿瘤药物安全性中的作用。方法针对1例服用阿帕替尼发生缺血性脑卒中的贲门癌患者,对其进行药学问诊,并进行文献检索,分析药物治疗及相关不良反应的发生情况,探究缺血性脑卒中的发病原因以及防范方法。结果患者发生缺血性脑卒中的原因与服用阿帕替尼所导致的不良反应相关。提高患者用药依从性以及对严重不良反应的识别可能有助于更好地控制和处理阿帕替尼的不良反应。结论阿帕替尼导致的缺血性脑卒中可对患者造成严重的不良结局。肿瘤临床药师应加强对口服靶向抗肿瘤药物患者的教育,尤其是长期院外用药的患者,正确应对和处理不良反应,识别严重不良反应的可能性,防范用药风险。     

Severe keloids caused by hydrogen cyanide injury: a case report

The purpose of this study was to report severe keloids caused by hydrogen cyanide injury. Hydrogen cyanide poisoning is still a problem as an occupational disease in China. We report a 37-year-old man with severe hydrogen cyanide poisoning. The patient fell on the floor after inhalation of hydrogen cyanide and was burned on his back by hydrocyanic acid. Sequential treatment included amyl nitrite by inhalation, intravenous sodium nitrite 3%, and intravenous sodium thiosulfate 25%. Other treatment consisted of incision of the trachea, mannitol and furosemide, antibiotics, and nutrient support measures. The patient also received hyperbaric oxygen therapy; during the first treatment, he became apneic and cardiopulmonary resuscitation was supplied in the hyperbaric oxygen chamber. He eventually recovered, but a large amount of keloids developed on his back and buttocks.     

Quadriplegia due to pachymeningitis, vasculitis and sepsis in a patient with rheumatoid arthritis: a case report

We report the case of a 84-year-old man, with history of rheumatoid arthritis, admitted the Hospital for a fall and complaining of dysaesthesia and pain located to the cervical spine and arms. Within a few hours after admission, fever and acute, progressive, ascendant quadriplegia became evident. Magnetic resonance imaging (MRI) of cervical spine showed spinal canal stenosis between C4-C6 with spinal cord compression. Hemocultures resulted positive for Staphylococcus aureus. The clinical picture rapidly evolved to sepsis with a fatal multi-organ failure. An autopsy found a osteosclerosis narrowing the neurocanal at the level of C3-C6, and recent cervical medulla infarction. A histological exam revealed the presence of a suppurative pachymeningitis with local phenomenas of periradiculitis, vasculitis and thrombosis of the anterior medullar artery, associated with coagulative necrosis of the neural tissue.     

补骨脂致药物性肝损伤一例

补骨脂为豆科植物补骨脂Psoralea corylifolia的干燥成熟果实,是一味常见的补虚药,按照炮制方法可分为生补骨脂和盐补骨脂。生补骨脂长于温补脾肾而止泻,外用治白瘢风;盐补骨脂温肾助阳、纳气、止泻之功较强,多用于阳痿遗精、遗尿、尿频等[1]。补骨脂的保健作用值得认可,但在应用过程中的用药安全问题值得关注。现将我院发现的1例补骨脂致药物性肝损伤报道如下。     

Subcutaneous phaeohyphomycosis due to Exophiala jeanselmei in an immunosuppressed patient: case report

A case of subcutaneous phaeohyphomycosis due to Exophiala jeanselmei, probably the first reported in New Zealand, is presented. This infection initially presented as two asymptomatic swellings overlying the left wrist of a 70 year old farmer with chronic respiratory and cardiovascular disease. A two month course of ketoconazole therapy proved ineffective and the patient subsequently died from his underlying medical condition.     

A farmworker death due to pesticide toxicity: a case report

In the state of California, the use of pesticides is closely regulated. Physicians are required to report all occupational illness attributable to pesticide use. The case of a death involving the handling of aldicarb, a potent methylcarbamate insecticide, is presented. Although the autopsy indicated trauma as the cause of death, subsequent analysis of tissue residues of aldicarb and its metabolites suggested that pesticide toxicity may have been a contributing cause.     

1例脑栓塞患者合并肌酶升高及肝损伤的原因分析

目的:对1例脑栓塞患者治疗过程中出现肌酶升高及肝损伤的原因进行讨论,提高临床药师运用专业知识对临床发生不良反应的判断和分析能力.方法:查阅文献,对该病例中发生肌酶升高和肝损伤不良反应的药物相关因素进行分析.结果:阿托伐他汀钙片可能是肌酶升高和肝损伤原因.结论:临床药师需要利用专业知识对药物不良反应进行分析和监护,提高患者用药安全性.     

Expression of CYP3A4 mRNA is correlated with CYP3A4 protein level and metabolic activity in human liver

A relatively large amount of human liver tissue was required to determine the exact activity of human hepatic CYP3A. Although, the quantity of available human liver tissue samples is limited. We measured levels of CYP3A4 mRNA by RT-PCR with a radiolabeled primer specific for CYP3A4 and compared mRNA expression with CYP3A4 protein level and metabolic activity in liver. The level of CYP3A4 mRNA was correlated with the levels of CYP3A4 protein and activity. Our results suggest that CYP3A4 protein and activity levels can be predicted from CYP3A4 mRNA levels determined by RT-PCR and using a very small amount of liver tissue.     

Mesalamine-induced lung injury in a patient with ulcerative colitis and a confounding autoimmune background: a case report

Two years after being diagnosed with ulcerative colitis, a 57-year-old man taking oral mesalamine experienced severe respiratory distress due to left lung pleuropneumonitis. Eight months later, severe respiratory distress recurred due to right lung pneumonitis. Extraintestinal manifestations of inflammatory bowel disease or mesalamine-induced pulmonary injury were considered in the differential diagnosis, which was complicated by a history of aseptic meningitis and evidence of an ongoing autoimmune response. The implications of the case are discussed.     

双环醇片引起乙肝患者肝功能恶化

患者男,33岁。因乏力、纳差半个月,于2003年10月9日来我院门诊就诊。患者于10年前体检发现HBsAg(+),HBeAg(+),抗HBc(+),ALT升高。间断服用澳太乐冲剂、金马肝泰片、甘草酸二铵等药物治疗,但肝功能仍未恢复正常,ALT最高达200U·L-1。2002年8月,口服中药汤剂治疗3个月,疗效不明显。2002年12月,在外院检测HBVDNA2.13×105copies·ml-1。2003年2月19日,经医生建议,自购双环醇片治疗。治疗方法为:25mg,po,tid。治疗1个月后复查肝功能,ALT降至正常。治疗4个月后复查,ALT仍正常,HBVDNA(-),e抗原阴转,e抗体(+)。因双环醇片治疗有效,为…     

Effect of glycyrrhizin on the activity of CYP3A enzyme in humans

Background

Glycyrrhizin is a major ingredient of licorice which is widely used in the treatment of various diseases such as chronic hepatitis. Licorice or glycyrrhizin has been shown to alter the activity of CYP3A in rodents. The influence of glycyrrhizin on CYP3A has not been elucidated in humans.

Objective

To investigate the effects of repeated glycyrrhizin ingestion on the oral pharmacokinetics of midazolam, a probe drug for CYP3A activity in humans.

Methods

Sixteen healthy adult male subjects were enrolled in a two-phase randomized crossover design. In each phase the volunteers received placebo or glycyrrhizin for 14 days. On the 15th day, midazolam was administered and blood samples were obtained to determine midazolam plasma concentrations. Bioequivalence was assessed by determining geometric mean ratios (GMRs) and 90% confidence intervals (90% CI).

Results

The geometric mean (geometric coefficient of variation) for the $ {\hbox{AU}}{{\hbox{C}}_{0 - \infty }} $ of midazolam in the placebo group was 196.4 ng·h/ml (30.3%) and after glycyrrhizin treatment, 151.3 ng·h/ml (34.7%). The GMRs and 90% CI for $ {\hbox{AU}}{{\hbox{C}}_{0 - \infty }} $ and C_max of midazolam in the presence/absence of glycyrrhizin were 0.77 (0.70, 0.89) and 0.83 (0.74, 1.01), respectively. The 90% CI for $ {\hbox{AU}}{{\hbox{C}}_{0 - \infty }} $ and C_max for the GMR of glycyrrhizin over placebo were both out of the no-effect boundaries of 0.80–1.25.

Conclusions

Administration of glycyrrhizin resulted in a modest induction of CYP3A that was clinically relevant according to the bioequivalence analysis.     

Severe ciguatera poisoning in Madagascar: A case report

In a single outbreak on the East coast of Madagascar, more than 500 people, 98 of whom died, were poisoned by the flesh of a shark, Carcharhinus amboinensis. From clinical symptoms it can be concluded that this poisoning is due to ciguatera toxins. It is the first case of a severe outbreak caused by a shark, and it is the first case with a mortality rate of 20%.