A 31-year-old female patient with schizophrenia got pregnant naturally during the treatment with clozapine (50 mg/d) and had been taking the drug during the pregnancy. Prenatal fetal ultrasound and chromosome examination showed no obvious abnormalities. The mother received subcutaneous injections of insulin aspart injection and insulin detemir injection and oral iron polysaccharide complex capsules for gestational diabetes mellitus and mild anemia successively during pregnancy. One live male infant was delivered by cesarean section at 39 +2 weeks of gestation, with a birth weight of 3 280 g. The infant′s Apgar score was 10. Physical examination of the newborn showed scattered ecchymosis on limbs skin, pinpoint-like petechiae on whole-body skin, and arrhythmia by heart auscultation. Laboratory tests showed prothrombin time 14.4 s, activated partial thromboplastin time 69.4 s, thrombin time 22.9 s, fibrinogen 1.27 g/L, and platelet count 366×10 9/L. Neonatal coagulation dysfunction was diagnosed, which was considered to be possibly related to clozapine. Intravenous infusions of vitamin K 1 injection and human fibrinogen were given. Four days later, ecchymosis and petechiae on his whole body were less than before, prothrombin time was 11.4 s, activated partial thromboplastin time was 45.0 s, thrombin time was 20.6 s, and fibrinogen was 2.22 g/L. Eight days later, his ecchymosis and petechiae basically disappeared.

A 31-year-old female patient with schizophrenia got pregnant naturally during the treatment with clozapine (50 mg/d) and had been taking the drug during the pregnancy. Prenatal fetal ultrasound and chromosome examination showed no obvious abnormalities. The mother received subcutaneous injections of insulin aspart injection and insulin detemir injection and oral iron polysaccharide complex capsules for gestational diabetes mellitus and mild anemia successively during pregnancy. One live male infant was delivered by cesarean section at 39 +2 weeks of gestation, with a birth weight of 3 280 g. The infant′s Apgar score was 10. Physical examination of the newborn showed scattered ecchymosis on limbs skin, pinpoint-like petechiae on whole-body skin, and arrhythmia by heart auscultation. Laboratory tests showed prothrombin time 14.4 s, activated partial thromboplastin time 69.4 s, thrombin time 22.9 s, fibrinogen 1.27 g/L, and platelet count 366×10 9/L. Neonatal coagulation dysfunction was diagnosed, which was considered to be possibly related to clozapine. Intravenous infusions of vitamin K 1 injection and human fibrinogen were given. Four days later, ecchymosis and petechiae on his whole body were less than before, prothrombin time was 11.4 s, activated partial thromboplastin time was 45.0 s, thrombin time was 20.6 s, and fibrinogen was 2.22 g/L. Eight days later, his ecchymosis and petechiae basically disappeared.

Objective To investigate the survival of advanced stage periampullary carcinoma and its prognostic factors.Methods The clinical data and follow up of 134 patients with advanced stage periampullary carcinoma admitted to our hospital between January 2007 and December 2010 were retrospectively collected and analyzed.Results Of 134 patients,there were 83 males and 51 females.The mean age±S.D.was 62.49±11.41 (28-83).For the 86 patients who underwent surgery,32 had extensive peritoneal metastases on surgical exploration,27 had metastases/involvement of the liver or stomach,and 27 had major vessel infiltration.For these 86 patients,55 received surgical exploration,whereas 31 had surgical exploration plus bypass anastomosis. 45 patients received chemotherapy,while 67 received chemotherapy plus radiotherapy.The improvements in quality of life and in clinical response rate after concurrent chemoradiotherapy or chemotherapy alone were 73.1％ and 57.8％,respectively.The overall survival was 14.27±1.06 months.The median survival time was 11 (8.95±13.05) months.The 1- and 3-year survival rates were 43％ and 10％,respectively.Karnofsky performance status,and the presence or absence of jaundice co-related with poor prognosis on single factor analysis.The Karnofsky performance status was an independent survival predictor on multifactor analysis.Conclusions The prognosis of patients with advanced stage periampullary carcinoma was poor.Chemotherapy with or without radiotherapy had similar impact on overall survival,Karnofsky performance status was an independent survival predictor.