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OBJECTIVE：To investiga te main risk factors for adverse drug reactions （ADR）of skin by intravenous injection of iodine contrast agent. METHODS ：From Jan. 2009 to Apr. 2020，the patients suffering from skin ADR after enhanced CT with iodine contrast agent were collected from our hospital. The basic information ，laboratory test results before using iodine contrast agent and ADR related information were collected through hospital information system （HIS）. The use of iodine contrast agent ，main manifestations of skin ADR and drug combination were analyzed statistically. Taking the sex ，age，body mass index （BMI），the dosage of iodine contrast agent ，length of stay ，laboratory examination ，tumor history ，basic disease ，allergy history ，drinking history as independent variables ，the incidence of skin ADR related to iodine contrast agent was analyzed by single factor analysis ，and the variables with statistically significant were selected for multivariate Logistic stepwise regression analysis. RESULTS ：There were 157 cases of skin ADR ，involving 79 males（50.3％）and 78 females（49.7％）. The age ranged from 19 to 86 years old ，being（52.68± 18.73）years old in average. BMI was 14.6-40.7 kg/m2，being（22.5±3.7） kg/m2. 67 cases（42.68％）were treated with iprodione ，34 cases（21.66％）with iodixanol ，31 cases（19.74％）with iohexol and 25 cases（15.92％）with iopamidol ；the dose of iodine contrast agent were 50-100 mL，being（73.06±13.29）mL in average. There was no significant difference among different dosage of 4 kinds of iodine contrast agents （P≤0.05）. Among 4 kinds of iodine contrast agents ，the incidence of skin ADR induced by iopromide was the highest（0.197％）. The skin ADR related to iodine contrast agent was mainly acute （89.2％），the severity was mild （75.2％），and urticaria（38.9％）was the most common. After symptomatic treatment ，135 cases were cured ，13 cases were improved and 9 cases were not improved. Among the patients with iodine contrast agent related skin ADR ，the incidence of ADR induced by combined use of anti infective drugs was the highest （33.1％）；however，the combined use of anti-tumor drugs was the main cause of severe skin ADR. The length of stay ｛11～20 d[OR＝1.21，95％CI（1.07，1.20），P＝0.042]、21～30 d[OR＝1.39，95％CI（1.12，1.52），P＝0.035]、31～40 d[OR＝1.15，95％CI（1.03，1.37），P＝0.008]、＞40 d[OR＝1.33，95％CI（1.28，1.53），P＝0.003]｝，respitatory and circulatory system tumor history[OR ＝1.51，95％CI（1.35，1.61），P＝0.037]，injection allergy history[OR ＝1.50，95％CI（1.37，1.59），P＝0.005] can significantly increase the incidence of iodine contrast agent related skin ADR. CONCLUSIONS ：The main manifestation of skin ADR related to iodine contrast agent was urticaria. The main risk factors of skin ADR related to iodine contrast agent were length of stay （＞ 10 d），respiratory and circulatory system tumor history and injection allergy history.
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The rotation of clinical pharmacists in anti-infection specialty is an important part of standardized training. In view of the poor foundation of imaging diagnosis ability, short rotation time and unsystematic training scheme, the quality of standardized training has been significantly improved through strict management system, strengthening entrance education, reforming academic lecture mode, setting up tutorial system for training students and refining assessment system. It's of great significance for clinical pharmacists in the direction of anti-infection to understand systemic infection.
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Objective@#To investigate the application value of magnetic resonance imaging (MRI) in the classification diagnosis of rectal mucinous adenocarcinoma.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of 74 patients with rectal mucinous adenocarcinoma who were admitted to Chongqing Traditional Chinese Medicine Hospital from July 2009 and February 2019 were collected. There were 40 males and 34 females, aged (46±8)years, with a range from 32 to 82 years. Among the 74 patients, 41 were simple mucinous adenocarcinoma, 26 were partial mucinous adenocarcinoma, and 7 were focal or small foci mucinous adenocarcinoma. All patients underwent MRI plain scan and dynamic enhanced scan. Observation indicators: (1) morphology of rectal mucinous adenocarcinoma; (2) the lesion margin of rectal mucinous adenocarcinoma; (3) the value of apparent diffusion coefficient (ADC) of rectal mucinous adenocarcinoma; (4) internal enhancement features of rectal mucinous adenocarcinoma; (5) timesignal intensity curve of rectal mucinous adenocarcinoma. Measurement data with normal distribution were represented as Mean±SD, and count data were described as absolute numbers.@*Results@#(1) Morphology of rectal mucinous adenocarcinoma: 74 patients had different morphological changes. Among the 41 cases of simple mucinous adenocarcinoma, 22 were oval, 8 were round, and 11 were irregular. Among the 26 patients with partial mucinous adenocarcinoma, 15 were oval, 8 were round and 3 were irregular. Among the 7 patients with focal or small foci mucinous adenocarcinoma, 2 were oval, 1 was round and 4 were irregular. (2) The lesion margin of rectal mucinous adenocarcinoma: the lesion margin of 74 patients was mainly unclear and irregular. Among the 41 cases of simple mucinous adenocarcinoma, 32 had unclear and irregular margin, 7 had clear margin, and 2 had unclear margin combined with fissure. Among the 26 cases of partial mucinous adenocarcinoma, 20 had unclear margin combined with fissure, 5 had unclear margin and irregular margin, and 1 had clear margin. Among the 7 patients with focal or small foci mucinous adenocarcinoma, 5 had unclear or irregular margin, 1 had unclear or irregular margin, and 1 had clear margin. (3) The value of ADC of rectal mucinous adenocarcinoma: diffusion weighted imaging of 74 patients showed diffused limited changes. The average ADC value was (1.24±0.23)×10-3 mm2/s of 41 patients with simple mucinous adenocarcinoma, (0.91±0.42)×10-3 mm2/s of 26 patients with partial mucinous adenocarcinoma, and (1.07±0.24)×10-3 mm2/s of 7 patients with focal or small mucinous adenocarcinoma. (4) Internal enhancement features of rectal mucinous adenocarcinoma: 74 patients showed delayed heterogeneous enhancement and marginal enhancement. Among 41 cases of simple mucinous adenocarcinoma, 24 showed delayed heterogeneous enhancement, 17 showed marginal enhancement, and none showed homogeneous enhancement. Among 26 patients with partial mucinous adenocarcinoma, 20 showed marginal enhancement, 6 showed homogeneous enhancement, and none showed heterogeneous enhancement. All the 7 cases of focal or small foci mucinous adenocarcinoma showed heterogeneous enhancement. (5) Timesignal intensity curve of rectal mucinous adenocarcinoma: 74 patients showed mainly outflow type in the timesignal intensity curve. Among the 41 cases of simple mucinous adenocarcinoma, 22 presented progressive curve, 12 presented platform type, and 7 presented outflow type. Among the 26 patients with partial mucinous adenocarcinoma, 17 presented outflow type, 8 presented platform type, and 1 presented progressive type. Among the 7 patients with focal and small forci mucinous adenocarcinoma, 4 presented outflow type, 2 presented platform type, and 1 presented progressive type.@*Conclusions@#MRI findings show different results for different types of rectal mucinous adenocarcinoma. A correct understanding of the MRI features of different types of rectal mucinous adenocarcinoma is helpful for the classification diagnosis of rectal mucinous adenocarcinoma.
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Objective To investigate the application value of magnetic resonance imaging (MRI) in the classification diagnosis of rectal mucinous adenocarcinoma.Methods The retrospective and descriptive study was conducted.The clinical data of 74 patients with rectal mucinous adenocarcinoma who were admitted to Chongqing Traditional Chinese Medicine Hospital from July 2009 and February 2019 were collected.There were 40 males and 34 females,aged (46± 8)years,with a range from 32 to 82 years.Among the 74 patients,41 were simple mucinous adenocarcinoma,26 were partial mucinous adenocarcinoma,and 7 were focal or small foci mucinous adenocarcinoma.All patients underwent MRI plain scan and dynamic enhanced scan.Observation indicators:(1) morphology of rectal mucinous adenocarcinoma;(2) the lesion margin of rectal mucinous adenocarcinoma;(3)the value of apparent diffusion coefficient (ADC) of rectal mucinous adenocarcinoma;(4) internal enhancement features of rectal mucinous adenocarcinoma;(5) timesignal intensity curve of rectal mucinous adenocarcinoma.Measurement data with normal distribution were represented as Mean ±SD,and count data were described as absolute numbers.Results (1) Morphology of rectal mucinous adenocarcinoma:74 patients had different morphological changes.Among the 41 cases of simple mucinous adenocarcinoma,22 were oval,8 were round,and 11 were irregular.Among the 26 patients with partial mucinous adenocarcinoma,15 were oval,8 were round and 3 were irregular.Among the 7 patients with focal or small foci mucinous adenocarcinoma,2 were oval,1 was round and 4 were irregular.(2) The lesion margin of rectal mucinous adenocarcinoma:the lesion margin of 74 patients was mainly unclear and irregular.Among the 41 cases of simple mucinous adenocarcinoma,32 had unclear and irregular margin,7 had clear margin,and 2 had unclear margin combined with fissure.Among the 26 cases of partial mucinous adenocarcinoma,20 had unclear margin combined with fissure,5 had unclear margin and irregular margin,and 1 had clear margin.Among the 7 patients with focal or small foci mucinous adenocarcinoma,5 had unclear or irregular margin,1 had unclear or irregular margin,and 1 had clear margin.(3) The value of ADC of rectal mucinous adenocarcinoma:diffusion weighted imaging of 74 patients showed diffused limited changes.The average ADC value was (1.24 ± 0.23) × 10-3 mm2/s of 41 patients with simple mucinous adenocarcinoma,(0.91±0.42)× 10-3 mm2/s of 26 patients with partial mucinous adenocarcinoma,and (1.07±0.24)× 10-3 mm2/s of 7 patients with focal or small mucinous adenocarcinoma.(4) Internal enhancement features of rectal mucinous adenocarcinoma:74 patients showed delayed heterogeneous enhancement and marginal enhancement.Among 41 cases of simple mucinous adenocarcinoma,24 showed delayed heterogeneous enhancement,17 showed marginal enhancement,and none showed homogeneous enhancement.Among 26 patients with partial mucinous adenocarcinoma,20 showed marginal enhancement,6 showed homogeneous enhancement,and none showed heterogeneous enhancement.All the 7 cases of focal or small foci mucinous adenocarcinoma showed heterogeneous enhancement.(5) Timesignal intensity curve of rectal mucinous adenocarcinoma:74patients showed mainly outflow type in the timesignal intensity curve.Among the 41 cases of simple mucinous adenocarcinoma,22 presented progressive curve,12 presented platform type,and 7 presented outflow type.Among the 26 patients with partial mucinous adenocarcinoma,17 presented outflow type,8 presented platform type,and 1 presented progressive type.Among the 7 patients with focal and small forci mucinous adenocarcinoma,4 presented outflow type,2 presented platform type,and 1 presented progressive type.Conclusions MRI findings show different results for different types of rectal mucinous adenocarcinoma.A correct understanding of the MRI features of different types of rectal mucinous adenocarcinoma is helpful for the classification diagnosis of rectal mucinous adenocarcinoma.
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OBJECTIVE: To explore the role of clinical pharmacists in anti-infective treatment for the patient with septic shock induced by intrauterine infection. METHODS: Clinical pharmacists participated in anti-infective treatment for a patient with septic shock induced by intrauterine infection, and assisted physicians to formulate empirical anti-infective treatment, determine that Escherichia coli was pathogenic bacteria and analyze the causes of fluctuations in body temperature. According to the patient's disease condition and results of assistant examination, clinical pharmacists suggested using Imipenem and cilastatin sodium for injection 1. 0 g, ivgtt, q6 h, stopping Teicoplanin for injection, de-escalation using Cefoxitin sodium for injection 2. 0 g, ivgtt, q8 h for anti-infective treatment, with oral sequential therapy. RESULTS: Physicians adopted most advice of pharmacists. After 30 d anti-infective and symptomatic treatment, the patients symptoms were better than before, and discharged from the hospital. CONCLUSIONS: Clinical pharmacists participate in formulating individual anti-infective treatment regimen, so as to promote the rational use of antibiotics and improve the response rate and success rate of treatment.
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Objective To evaluate the clinical value of MRI examination in the diagnosis and guidance of operation complexity a-nal fistula.Methods Preoperative MRI findings of 32 patients with complex anal fistula confirmed by operation were analyzed ret-rospectively,and compared with the operation results.Results The pre-operation MRI results of 32 patients with complex anal fis-tula revealed that there were 43 fistulas,10 anus week abscesses,58 orificium fistulas,comparing the MRI diagnosis with operation results,coincidence rate of fistula,anus week abscesses,orificium fistula was 100.0%,100.0%,89.3%,respectively.MRI manifes-tations of fistula were that T1 WI manifestations of fistula was or low signal,T2 WI and T2 WI fat suppression sequence manifesta-tions of fistula was high signal,fistula presented a tubular shape obviously as T1 WI enhancement scanning,internal opening repre-sented as intensive dot,complicated embranchment,two type signal of fistula appeared at the same time.MRI manifestations of ab-scesses were that circular,ellipse,irregular form and horseshoe-shape,T1 WI manifestations of abscesses was low signal,there was gas in abscess cavity of some patients;intestinal tube surrounding of some patients were involved by abscess cavity,and up through the edge of bladder to the perineum.Conclusion MRI examination could accurately display the number of complex anal fistula,fis-tula walking and branch,the position of internal opening,correlativity between fistula and surrounding muscles,status of abscess, which could provide guidance for anorectal surgery.