氟喹诺酮类药物不良反应168例分析

0 引言 随着氟喹诺酮类药物在临床的广泛应用，有关其应用所致不良反应的报道也日趋增多，我们通过对1990／2003年我院氟喹诺酮类药物不良反应情况报告如下，供临床参考。     

A comparison of midazolam with trimeprazine as an oral premedicant for children

The effect of oral premedication was investigated in a double-blind, randomised trial in 85 children undergoing tonsillectomy and/or adenoidectomy. Orally administered midazolam 0.5 mg.kg⁻¹ given 30 min pre-operatively was compared with trimeprazine 2 mg.kg⁻¹ given 90 min pre-operatively and a placebo preparation. Compliance, sedation and ease of induction were assessed as were the duration and quality of recovery. Following premedication with midazolam none of the patients was anxious, crying or distressed on leaving the ward, compared with 2/28 in the trimeprazine group and 5/28 in the placebo group (p =0.0007). More patients were calm and quiet on arrival in the anaesthetic room following midazolam than following trimeprazine, with both premedicant agents comparing favourably with placebo. There was no significant difference between the three groups in the time to recovery or the sedation score on discharge to the ward. Midazolam is a safe and effective oral premedicant for children.     

Curietherapy using a ruthenium and iridium disk in the treatment of choroid melanoma

Following the experience of the German authors, the treatment of choroidal melanoma with ruthenium 106 disk was introduced in Lyon. Between 1983 and 1988, 127 patients were treated. Results are analysed on a group of 84 patients followed 18 months and more. In 72 cases a reduction of thickness was noted. It was complete in 33 cases. Enucleation was performed in 10 patients due to no response or regrowth. In 3 cases the tumor was sterilized. Five patients died of metastases, and 73 are alive, 3 of them with liver metastases. An afterloading iridium template disk was used in 8 patients. 4 of them with a tumor thickness between 6.5 and 8 mm had a good response. Edema of the fovea was observed in 21% of cases, while cataracts were very unusual with Ru 106. An enucleation was performed in 6 patients because of a complication. A useful vision may be preserved in 60% of cases. The scleral tolerance dose is close to 1,500 Gy. These results are in agreement with those of the literature and are considered to be satisfactory for tumors not exceeding 5 to 6 mm in thickness. If the tumor is located close to the fovea or the papilla, and/or if the thickness is 8 mm or more, proton beam could be a good alternative.     

Candidiasis involvement of the small intestine complicated by perforation. A case of favorable course

We report the case of a 51 year-old man who developed candidiasis of the small bowel associated with intestinal perforation. This condition is very rarely recognized ante mortem. Here, the diagnosis was established by pathological examination of a surgically resected specimen of small bowel at the time of surgery. A complete work-up failed to disclose any predisposing condition to digestive candidiasis. Antifungal therapy resulted in complete recovery.     

Mycobacterial infections following heart valve replacement.

Mycobacterial infection is an uncommon but very serious complication of heart valve replacement and other forms of cardiac surgery. Tuberculosis has been a rare complication of valve replacement in the industrially developed countries owing to the low incidence of that disease in such countries. Most reported cases are associated with the insertion of human allograft valves. Valvular tuberculosis could become a more serious problem if heart valve replacement surgery is used to any extent in countries where tuberculosis is common. The majority of other mycobacterial infections occurring after heart surgery have, for unknown reasons, been due to the rapid growers M. chelonae and M. fortuitum. Porcine xenograft valves have been contaminated by M. chelonae, possibly during manufacture as this is not a natural pathogen of pigs. A minority of patients receiving valves known to be contaminated by M. chelonae subsequently developed valve disease. Mycobacterial disease following insertion of mechanical valves is a very uncommon occurrence but the prognosis is poor. There have been several outbreaks of infection of the sternotomy wound by M. chelonae and M. fortuitum and, although the prognosis is better than for mycobacterial endocarditis, treatment, especially for infections due to M. chelonae, often involves extensive debridement including removal of the entire sternum. In view of the poor response to therapy, prevention by avoidance of contamination of all surgical materials, including implanted valves, by environmental mycobacteria is of paramount importance.     

Segmentectomies in the management of liver tumors

Between 1982 and 1986, liver segmentectomies were performed in 19 patients with liver tumors, including ten hepatocellular carcinomas, six liver metastases, one cholangiocarcinoma, and two benign tumors. During surgery, patients received a mean (+/- 1 SD) of 1050 +/- 150 mL of packed red blood cells and 860 +/- 80 mL of fresh-frozen plasma. There were no operative deaths. The only complication was a prolonged leakage of ascites through the abdominal drain in one patient with cirrhosis. Seven patients with hepatocellular carcinoma were still alive at this writing, with a follow-up ranging from two months to four years. The four patients with metastases from colorectal carcinomas were alive after follow-up times ranging from six to 24 months. These results suggest that liver segmentectomy is a safe procedure and should be considered as the operation of choice for resection of limited liver tumors.     

Friction, capacitance and transepidermal water loss (TEWL) in dry atopic and normal skin

The biophysical properties of non-eczematous skin at three locations in atopics and non-atopics were characterized using non-invasive physical methods. Skin friction was measured with a newly developed sliding friction instrument, the degree of hydration with a capacitance meter (Corneometer CM 820), and the transepidermal water loss (TEWL) was determined using an Evaporimeter EP1. The areas examined (dorsum of the hand, volar forearm and lower back) showed lower values of friction and capacitance in the atopic patients than did corresponding sites in the normal controls. In most areas a significant correlation between friction and capacitance was found. The TEWL was increased in atopic skin, but TEWL seems to correlate neither to friction nor to capacitance.