万古霉素致失代偿期肝硬化患者重度血小板减少1例

万古霉素是一种糖肽类抗生素,临床主要用于治疗包括耐甲氧西林金黄色葡萄球菌在内的侵袭性革兰阳性菌感染。该药常见不良反应为皮疹、肾毒性及耳毒性,较少引起血小板减少。本文报道1例由万古霉素导致重度血小板减少的失代偿期肝硬化患者,为此类不良反应的临床监测及治疗提供参考。     

肝性低氧血症与肺功能、一氧化氮和内皮素-1相关性研究

呈负相关(r=-0.287,P=0.026),二者均与肝性低氧血症无相关性(P>0.05).结论 肝性低氧血症在肝硬化早期肺功能即有改变,一氧化氮及内皮素-1虽共同参与肝硬化发展,但非促成肝性低氧血症的因素.     

Dry eye syndrome in patients with biliary cirrhosis]

Ophthalmic state of 18 women patients between 40 and 69 years of age with primary biliary cirrhosis (PBC) was studied. Tear secretion was studied by Schirmer I., break up time and conjunctival and corneal bengal rose staining tests. In 15 cases serious degree of keratoconjunctivitis sicca has been revealed. Xanthelasma of the lid was found in three patients. Visual functions were intact. Kayser-Fleischer ring was absent in every case. There was no connection between the duration or laboratory characteristics of the PBC and the severity of the keratoconjunctivitis sicca. In nine patients of the cases requiring tear substitution eye drops of methylcellulosum available in Hungary were insufficient. Hydroxypropyl-methylcellulosum drops of eye gel containing peptides of low molecular weight eliminated the symptoms in these cases. The authors emphasize that PBC should be considered as a possible underlying disease in women over 30 years with severe dry eye syndrome.     

Severe osteomalacia in a patient with idiopathic chronic pancreatitis

We report a 30-year-old woman who was confined to a wheelchair because of severe myopathy. She was first seen by a neurologist because of a convulsive syndrome of unknown etiology when she was nine. She was started on anticonvulsive drugs but the drug was stopped when her serum calcium level was found to be very low. She had a history from childhood of steatorrhea and abdominal pain after a fatty meal and became vegetarian at age five years. She worked in a hospital as a nurse and at home her living room received no direct sunlight. As a result of these conditions osteomalacia progressed. We believe an awareness of chronic pancreatitis (CP) during childhood could have prevented the consequences of the disease in this case.     

Liver cirrhosis due to chronic use of nitrofurantoin

A 74-year-old woman was admitted with jaundice. She was suffering from generalised liver failure with a highly prolonged prothrombin time, a low albumin level and ascites. Further anamnesis revealed that she had been taking nitrofurantoin as a prophylactic agent for recurrent urinary tract infections every day for 5 years. Because of the indications for liver damage due to nitrofurantoin, the drug was discontinued immediately on admission. After withdrawal of nitrofurantoin there was a very gradual clinical and biochemical improvement. Liver biopsies to confirm the diagnosis revealed extensive liver damage with cirrhosis such as may be seen following long-term use of nitrofurantoin. Nitrofurantoin should be prescribed with caution as a prophylactic agent in elderly women and patients with renal dysfunction because the risk of liver damage as a serious side effect of nitrofurantoin is greatly increased in these patients.     

重视慢性乙型肝炎肝硬化的抗病毒治疗

慢性乙型肝炎(乙肝)是危害全球健康的一大问题,全球有3.5亿慢性乙肝病毒携带者,其中有75%的患者在亚太地区,同时慢性乙肝也是我国肝硬化患者最主要的发病原因.     

Severe chronic obstructive pulmonary disease in young women who smoke

Chronic obstructive pulmonary disease (COPD) was diagnosed in three women aged 39, 41 and 41 years who were all heavy smokers. They presented with symptoms of dyspnoea. At the time of diagnosis they already had advanced pulmonary emphysema and signs of systemic impairment. At the last follow-up one woman had a very limited range of action, the second was awaiting a lung transplant after several periods of hospitalization, and the third had died. Nowadays pneumologists are increasingly encountering severe COPD in young female patients. Increased tobacco consumption in women has run parallel to the rising mortality rates from COPD in females over the last decades. Cigarette smoking is probably associated with a higher risk of obstructive lung disease in women than in men. Moreover women with COPD maintain exercise capacity longer than men with similar degrees of airway obstruction, leading to a risk of them waiting too long before seeking medical help. Actions aimed at discouraging smoking especially in adolescence are without doubt the intervention of choice for prevention of this highly disabling disease.     

慢性病毒性肝炎肝硬化合并慢性肾脏病病人的营养状况分析

目的:分析慢性病毒性肝炎肝硬化与慢性病毒性肝炎肝硬化合并慢性肾脏病(CKD)病人的营养状况。方法:选择慢性病毒性肝炎肝硬化病人105例,按是否合并CKD分为肝硬化组和肝硬化合并CKD组,记录入院时病人的性别、年龄、肝病病程、肾病基础疾病、肝功能Child-Pugh分级、血清白蛋白(ALB)、前白蛋白(PA)、血红蛋白(Hb)、淋巴细胞(L)绝对值、肾功能指标,体重指数(BMI)、三头肌皮褶厚度(TSF)、握力、欧洲营养风险筛查2002(NRS 2002)和主观整体评估(SGA)法对病人进行营养筛查与评估。结果:肝硬化组与肝硬化合并CKD组化验指标ALB、HB明显低于正常,两组间比较具有统计学意义;应用BMI、握力、TSF测量评价病人营养状况时,肝硬化组与肝硬化合并CKD组之间无统计学意义。肝硬化组与肝硬化合并CKD组应用NRS 2002营养风险发生率分别为32.81%和65.85%,两组间比较有统计学意义,尤其在Child-Pugh B级和C级病人;SGA评估营养不良发生率分别为28.12%和58.54%,两组间比较有统计学意义,但只在Child-Pugh B级病人有显著性差异。结论:合并CKD的肝硬化病人,营养风险发生率升高,随着肝硬化疾病的进展,营养风险及营养不良发生率进一步升高。