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Dołączył: 21 Lut 2011
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 Wysłany: Pią 6:41, 18 Mar 2011 Temat postu: vibram five fingers outlet dsn mha urif rie |
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Norvancomycin cause allergic dermatitis
, Abdominal pain, bloating 2 weeks, at a local hospital diagnosed as tuberculous peritonitis, oral administration of isoniazid 0-3g, 1 times / d, rifampicin 0.45g, 1 times / d, pyrazinamide O. 25g,[link widoczny dla zalogowanych], 3 times / d service. 3d after subcutaneous ecchymosis, u cavity mucosal blood blisters, bleeding gums, on January 8, 2005 to our hospital for treatment. With previous history of pulmonary tuberculosis 8 years, intermittent isoniazid, rifampicin, pyrazinamide, no history of drug allergy and radiation exposure history. Physical examination: T36.5 ~ C, P84 times / min, Rl6 times / min, BP120/75mmHg (1mmHg0.133kr 'a), skin and mucous membranes of varying sizes scattered ecchymosis, petechiae, oral mucosa and tongue edge of the number of blood blister, a small amount of bleeding gums, superficial lymph nodes big or small, no tenderness sternum, lungs, heart revealed no abnormalities, abdominal wall soft, shifting dullness (+), hit the end of mass. Laboratory examinations; ① blood: WBC4.2xl fan, Hb90g / L, PLT1xlO ~ / L: ② bone marrow as: bone marrow hyperplasia, grain red two-line, the lymphatic system to normal, active proliferation of giant nuclear systems, the entire film 101 of megakaryocytes,[link widoczny dla zalogowanych], l8 a infantile type, particle type 73, megakaryocytic type 6, middle panels 4, mature platelets showed a single distribution, consistent with bone marrow as thrombocytopenic purpura. ⑨ x-ray said: old lung tuberculosis: ④ abdominal B-show: a small amount of peritoneal fluid. Diagnosis: ① immune thrombocytopenic purpura; ② tuberculous peritonitis after admission to disable anti-TB drugs, given methylprednisolone 40mg / d intravenously, d, N the amount of gamma globulin 0.1g-kg-1ad. . , Intravenous infusion, and support for symptomatic treatment. 2 days after admission in patients with low fever, abdominal distension, diarrhea, tuberculosis peritonitis consider relevant, plus isoniazid 0.3g, 1 times / d, rifampicin O. 45g, 1 times / d, pyrazinamide O. 25g, 3 times / d treatment. A large number of the same day dosing period, I-lb reduced to 56g / L. Immediately stop using rifampin,[link widoczny dla zalogowanych], ethambutol 0.25g3 times instead, d,[link widoczny dla zalogowanych], and give intravenous infusion of red blood cell suspension 2IU, platelet 2OI 【J, plus vincristine (VCR), 2me, / intravenous drip Note. After 7d, PLT: 26xlOg / L, disable methylprednisolone. After 12d, PLT: 144 ~ 109 / L. Follow-up 6 months after discharge to maintain normal PLT, basic control of tuberculous peritonitis. Discussion of rifampicin rarely cause thrombocytopenic purpura], the mechanism of rifamycin class ① hapten attached to the platelet surface as to stimulate the body to produce antibodies, causing allergic reactions caused by platelet destruction, leading to immune platelet injury, so that thrombocytopenia. An anti-platelet drugs ② drugs for a three-antibody complexes activate complement repeat lead to platelet destruction of their clinical characteristics: asexual cut off the feet, the age difference, the majority of onset of exposure to rifampin 24h again, the light thrombocytopenia (50-80) ~ lO9 / L, no bleeding symptoms, stopping self-recovery; severe thrombocytopenia ( 20x10 ~ / L, the bleeding symptom control, that is, withdrawal, so as not to apply too long, so that TB become worse. Immunosuppressive agents vincristine and corticosteroids in combination, lower town and the amount of glucocorticoid action time, vincristine given early treatment, can reduce glucocorticoid treatment. 【4 1981 Iambach first time that such fire-dose intravenous gamma globulin treatment of idiopathic purpura small plates (ITP) effective. Qin Tiejun et al [51 confirmed that sub-standard doses of gamma ball Chi from the treatment of ITP with similar efficiency and the standard dose, patients with small doses of gamma globulin (0.1g / l 【g) treatment,[link widoczny dla zalogowanych], were able to quickly control bleeding and improve the body resistance.
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