Atypical presentations of methemoglobinemia from benzocaine spray

Widely used for local anesthesia, especially prior to endoscopic procedures, benzocaine spray is one of the most common causes of iatrogenic methemoglobinemia. The authors report an atypical case of methemoglobinemia in a woman presenting with pale skin and severe hypoxemia, after a delayed repeat exposure to benzocaine spray. Early recognition and prompt management of methemoglobinemia is needed in order to lessen morbidity and mortality from this entity.     

Methemoglobinemia resulting from absorption of nitrates

Three cases of toxic methemoglobinemia resulted from absorption of nitrate salts through burned skin areas. In addition to the unusual route of intoxication, this report emphasizes the occupational hazard of methemoglobinemia in workers exposed to nitrogen salts and the importance of rapid diagnosis and treatment. The diagnosis of methemoglobinemia should be suspected in any case of cyanosis refractory to oxygen therapy. Appropriate treatment should include oxygen, methylene blue, and exchange transfusion in clinically severe cases.     

Cyanosis following transesophageal echocardiogram

Topical anesthesia is routinely employed to facilitate diagnostic and therapeutic procedures that involve the oropharynx. Although this practice is usually safe, there is always the potential that methemoglobinemia might be induced by the topical anesthetic agent. The clinician should consider this possible complication when the patient experiences signs or symptoms of oxygen desaturation in the absence of another explanation. Because methemoglobinemia can be life-threatening, early recognition and treatment are extremely important.     

高铁血红蛋白血症26例临床分析

[背景 ]食物中毒引起的高铁血红蛋白血症 ,包括青紫引起的肠原性紫绀及亚硝酸盐、硝酸盐、黄胺类、苯胺等多种药物或化学药品中毒 .它多发生在 3岁以上患儿 .[病例报告 ]临床表现为颜面青紫 ,尤以口唇、口周青紫为著 ,甲床青紫也较明显 ,此外还表现为全身皮肤青紫、恶心呕吐、腹痛及全身不适 .心肺检查正常 .严重者表现为青紫严重 ,精神差 ,头痛 ,头晕 ,周身乏力 ,腹疼 ,恶心呕吐 ,呼吸急促 ,无呼吸困难 ,心率加快 ,肺部听诊无异常 .[讨论 ]患儿应注意饮食卫生 ,规则服药 .     

壮骨关节丸对大鼠肝微粒体P450的影响

[目的] 考察壮骨关节丸对大鼠肝微粒体细胞色素P450的影响。[方法] 壮骨关节丸及其两个新工艺按含生药2.1 g/kg连续给大鼠灌胃7 d,末次药后24 h断头处死大鼠并取肝脏,用钙沉降法制备肝微粒体。在体外用含氨苯砜、非那西丁、奥美拉唑、氯唑沙宗的cocktail探针代谢来考察肝微粒体CYP3A、CYP1A2、CYP2C19、 CYP2E1的活性。[结果] cocktail探针在体外肝微粒体系统中代谢1 h后,包括壮骨关节丸及其两个新工艺的给药组剩余氯唑沙宗浓度显著高于对照组,而奥美拉唑、非那西丁、氨苯砜浓度与对照组之间差异无统计学意义。[结论] 壮骨关节丸可以抑制大鼠肝脏CYP2E1活性,但对CYP1A2、CYP3A及CYP2C19无显著影响。     

Study of multidrug therapy in paucibacillary leprosy

A study was undertaken to evaluate the efficacy of multidrug therapy (MDT) in paucibacillary leprosy. Out of 155 fresh cases studied 48 had indeterminate, 38 tuberculoid and 69 had borderline tuberculoid leprosy. Out of 155 cases, 64 patients in the first group were treated with dapsone 100 mg daily for 12 months. In the second group, 91 patients were given MDT, consisting of rifampicin 600 mg once a month and dapsone 100 mg daily for consecutive 12 months. The cases receiving dapsone and the cases having MDT remained clinically active at the end of 6 months in 56.1% and 37.2% respectively; 13.1% of cases having single lesion and 66.3% of patients with multiple lesions were found to be active after 6 months of MDT. At the end of one year 79.6% cases receiving dapsone and 91.2% cases having MDT became inactive.     

Haemolysis associated with diazoxide, used for the control of hypertension

Diazoxide, an agent used occasionally in the control of hypertension, has been associated with three haemolytic episodes in one patient. It is suggested that the mode of action is similar to that of diaminodiphenyl sulphone (dapsone) in acting as an oxidant stress to the ageing erythrocyte.     

氨苯砜治疗激素依赖性哮喘的疗效观察

应用氨苯砜治疗２６例激素依赖性哮喘，另２４例用维生素Ｂ１治疗作对照，观察时间１２个月。结果显示氨苯砜应用６个月有１／３的病人激素停用，１２个月后有近２／３的病人激素停用。且能维持病情稳定，无明显副作用。表明氨苯砜可做为激素依赖性哮喘的激素替代药物。     

Isotretinoin in acne agminata

Acne agminata is an asymptomatic papulopustular eruption. This condition typically occurs in young adults. The eruption generally runs a self-limited course, but disfiguring scars can occur. Histological examination shows scattered dermal granulomas composed of epitheloid and some giant cells with central caseation. A variety of agents such as wide-spectrum antibiotics, oral steroids, dapsone, and clofazimine have been used with varying degrees of success. Herein, we report 2 Caucasian males with acne agminata, successfully treated with isotretinoin.     

普鲁卡因静脉麻醉对患者高铁血红蛋白含量的影响

本文对33例静脉普鲁卡因麻醉前后患者血液高铁血红蛋白(MHb)含量的影响做了观察。结果表明:静脉给予普鲁卡因后1小时患者血液内 MHb 的含量明显高于用药前,有显著性差异(P<0.001);而停药时 MHb 的含量与用药前无显著差异(P>0.1)。提示麻醉医师,用静脉普鲁卡因麻醉后1～2小时内要注意患者血液 MHb 增高而出现紫绀现象。     

A case of dapsone induced methaemoglobinaemia

Background  We present a case of dapsone induced methaemoglobinaemia that occurred in a patient who presented to the Emergency Department of a University Hospital. It is an uncommon condition that requires specific and urgent treatment in severe cases. Aims  To describe and evaluate the presenting symptoms, signs, diagnosis and management of acquired methaemoglobinaemia. Methods  We describe a case of acquired methaemoglobinaemia as a result of dapsone ingestion with a literature review. Conclusions  Acquired methaemoglobinaemia is an uncommon condition that presents with non-specific signs and symptoms. It is caused by a variety of exogenous agents and results in a “saturation gap” between oxygen saturation on pulse oximetery and arterial blood gas analysis. Specific treatment with intravenous methylene blue is the treatment of choice. Full resolution can be expected with treatment but severe cases can be associated with shock and mortality.     

Genetic disorders of human red blood cells.

Human red blood cells (RBCs) are subject to an enormous degree of genetic diversity. The variability that occurs may result in anemia, cyanosis, polycythemia, or may cause no hematologic alterations. Genetic abnormalities affecting hemoglobin include the sickling disorders, the unstable hemoglobinopathies, hemoglobinopathies associated with polycythemia or with methemoglobinemia, and the alpha- and beta-thalassemias. The most common enzymatic abnormality of RBCs is glucose-6-phosphate dehydrogenase deficiency, but defects of many other enzymes leading to hemolytic anemia have been identified. Deficiences of RBC enzymes may also be important in the diagnosis of nonhematologic disease and in the evaluation of dietary status.     

Multidrug therapy in leprosy

Leprosy is an ancient disease, which was treated by local application of chaulmoogra/hydnocarpus oil during prechemotherapeutic era. Since 1940, dapsone was the only chemotherapeutic agent used for treatment of leprosy for about three decades. Prolonged, interrupted and inadequate use of dapsone monotherapy, leads to development of dapsone-resistant cases. Usefulness of clofazimine was known in 1962. Introduction of rifampicin--a powerful bactericidal drug in 1970 has opened the avenues of multidrug therapy to treat leprosy. Multidrug therapy recommended by World Health Organisation came into practice after 1982. The regimen followed now is for duration of 6 months in paucibacillary and for the duration of 12 months in multibacillary cases. It is proven to be safe and effective. Multidrug therapy for leprosy cases is available in the form of blister calender packs and is available free of cost at all government health facilities. Although more new drugs such as ofloxacin, minocyclin, clarithromycin, etc, are known now but they are used as alternative drugs if a component of combination in multidrug therapy becomes contra-indicated. This article brings the details of various drugs used under multidrug therapy, their characteristics, side-effects, regimens and alternative drugs available for treating leprosy.     

氨苯砜对高危人群预防麻风效果的前瞻性观察

目的 研究高危儿童应用氨苯砜预防麻风病的效果。方法选择住院麻风病人在院内生育的76名子女为预防组，应用氨苯砜（DDS）作预防用药，用药时间2年；治愈出院病人在院外生育的87名子女为对照组，用维生素B，作安慰剂，并对两组进行比较。结果随访观察的163人中，完成25年全程随访者152人，占93．25％。预防组未见发病者，而对照组先后有8人发病，发病率为9．2％。结论DDS预防麻风显示有效，且具有近、中期的预防效果。     

The therapeutic and prophylactic role of oral zinc sulfate in management of recurrent aphthous stomatitis (ras) in comparison with dapsone

OBJECTIVE: To evaluate the therapeutic and prophylactic effectiveness of oral zinc sulfate in recurrent aphthous stomatitis (RAS) in comparison with dapsone. METHODS: A double-blind placebo controlled study, conducted in the Department of Dermatology, Baghdad Teaching Hospitals, Baghdad, Iraq between May 2005 and October 2006, in which 45 patients with RAS were recruited and divided into 3 equal groups: group A (on zinc sulfate 150 mg twice daily), group B (on dapsone 50 mg twice daily), and group C (on glucose 250 mg as placebo). The drugs were prepared in identical capsules, and the patients were instructed to take the capsules twice daily after meals (in a double-blind manner). Assessment of each patient was carried out by the Oral Clinical Manifestation Index (OCMI) and the diameter of the ulcers at day 0, day 4, and at the second, fourth, sixth, eighth, tenth, and twelfth weeks of therapy. RESULTS: Forty-five patients were included in the study (25 males and 20 females), and their ages ranged between 16-45 years (mean+/-SD 31.24+/-8.14). In group A, the mean of OCMI and diameter of ulcers improved, with a p=0.0001 for OCMI, and 0.0001 for the diameter for ulcers at the end of the twelfth week of therapy, which was statistically significant. Group B, also showed significant improvement, however, the action was lower and slower (p=0.0001 for OCMI, and 0.001 for the diameter for ulcers). Group C revealed slight non-significant improvement (p=0.028 for OCMI, and 0.034 for the diameter of ulcers). In the sixth week of therapy, zinc sulfate was more effective than dapsone in reducing the OCMI of the ulcers (p=0.007). CONCLUSION: The present study showed that both zinc sulfate and dapsone had significant therapeutic and prophylactic effects in controlling RAS, however, zinc sulfate had much more rapid and sustained action.     

Neural leprosy--a case report

Neural leprosy is rare. This is a report of a 63-year-old Indian man who had long standing multiple peripheral neuropathy. The slit skin smear for acid-fast bacilli of Mycobacterium leprae was positive. The skin and nerve biopsies were normal. He was treated with rifampicin, dapsone and clofazimine.     

An assessment of acetylator polymorphism and its relevance in Papua New Guinea

A number of clinically useful drugs such as isoniazid, sulphonamides, procainamide and dapsone are rapidly inactivated and eliminated metabolically by an acetyltransferase enzyme. The rate of elimination of these drugs is dependent upon the level of enzymatic activity, which is known to be genetically determined and exhibits ethnic and geographical variation. The study of acetylation polymorphism therefore is important especially in view of its effect on drug efficacy and toxicity. Limited information is available on the acetylation status of Papua New Guineans. Studies conducted so far have revealed an unusually high frequency of the rapid acetylator phenotype (greater than 90%) in certain populations. This study confirms the previous observations and reviews the world-wide distribution pattern of acetylation polymorphism.     

氨苯砜和蒿甲醚治疗大鼠卡氏肺孢子虫肺炎的疗效研究

目的研究氨苯砜和蒿甲醚对实验大鼠卡氏肺孢子虫肺炎的疗效。方法将wistar大鼠随机分为A、B实验组,以地塞米松皮下注射,诱发建立卡氏肺孢子虫肺炎动物模型。A组实验鼠5只,用氨苯砜治疗,50mg／只·次,灌服,2次/d,连用10d;B组实验鼠6只,用蒿甲醚治疗,20mg／只·次,肌注,1次/d,连用5d,首剂加倍。A、B组分别有1只为不治疗对照鼠。结果A组实验鼠在治疗后第12d基本恢复健康,对照鼠在第3d死亡;B组实验鼠在治疗后第8d基本恢复健康,对照鼠在第2d死亡。结论氨苯砜和蒿甲醚对卡氏肺孢子虫肺炎均有疗效。     

Agranulocytosis during malaria prophylaxis with Maloprim (pyrimethamine and dapsone)

A case of agranulocytosis during malaria prophylaxis with Maloprim (pyrimethamine and dapsone) is described. At the recommended dose of one tablet weekly this is apparently a rare occurrence but highlights one of the hazards in a changing climate of malarial prophylaxis in which the use of Maloprim is increasing.     

杀虫脒急性中毒症状高铁血红蛋白血症的探讨

目的探讨杀虫脒急性中毒是否全数或多数出现高铁血红蛋白血症。方法采用氰化高铁血红蛋白光电比色法测定杀虫脒急性中毒大鼠、家兔、家鸽及亚硝酸钠急性中毒家鸽血样中高铁血红蛋白的含量。结果上述杀虫脒急性中毒动物的血样中高铁血红蛋白的含量均属正常范围，而亚硝酸钠急性中毒家鸽血样中高铁血红蛋白的含量明显增加，二巯基丙磺酸钠不能还原由亚硝酸钠所致的高铁血红蛋白。结论杀虫脒急性中毒并非全数或多数出现高铁血红蛋白血症，高铁血红蛋白血症也并非是杀虫脒急性中毒死亡的主要原因。