1/243. Post-meningitic hydrocephalus and syringomyelia treated with a ventriculoperitoneal shunt.Following cryptococcal meningitis, symptoms of cervical syringomyelia developed in a young heroin addict. myelography confirmed syringomyelia and angiography demonstrated severe hydrocephalus. Ventriculoperitoneal shunting resulted in complete resolution of signs and symptoms of both hydrocephalus and syringomyelia.- - - - - - - - - - ranking = 1keywords = heroin (Clic here for more details about this article) |
2/243. mortality associated with new south wales methadone programs in 1994: lives lost and saved.OBJECTIVES: To estimate the effects of methadone programs in new south wales on mortality. DESIGN AND CASES: Retrospective, cross-sectional study of all 1994 new south wales coronial cases in which methadone was detected in postmortem specimens taken from the deceased. Cases were people we identified as patients in NSW methadone maintenance programs or those whose deaths involved methadone syrup diverted from maintenance programs. OUTCOME MEASURES: Relative risks of fatal, accidental drug toxicity in the first two weeks of treatment and later; the number of lives lost as a result of maintenance treatment; preadmission risks and the number of lives saved by maintenance programs, calculated from data from a previous study. RESULTS: There was very close agreement between this study's classifications and official pathology reports of accidental drug toxicity. The relative risk (RR) of fatal accidental drug toxicity for patients in the first two weeks of methadone maintenance was 6.7 times that of heroin addicts not in treatment (95% CI RR, 3.3-13.9) and 97.8 times that of patients who had been in maintenance more than two weeks (95% CI RR, 36.7-260.5). Despite 10 people dying from iatrogenic methadone toxicity and diverted methadone syrup being involved in 26 fatalities. In 1994, NSW maintenance programs are estimated to have saved 68 lives (adjusted 95% CI, 29-128). CONCLUSIONS: In 1994, untoward events associated with NSW methadone programs cost 36 lives in NSW. To reduce this mortality, doctors should carefully assess and closely monitor patients being admitted to methadone maintenance and limit the use of takeaway doses of methadone.- - - - - - - - - - ranking = 1keywords = heroin (Clic here for more details about this article) |
3/243. Focal rhabdomyolysis and brachial plexopathy: an association with heroin and chronic ethanol use.A 22-year-old man presented with acute swelling of the left neck and associated weakness of the left arm upon awakening after having snorted heroin. He had consumed large amounts of ethanol regularly for 7 years. serum creatine kinase was greater than 19,000 units/l. A diagnosis of focal rhabdomyolysis and left brachial plexopathy was made. Focal rhabdomyolysis with associated plexopathy is an uncommon but recognized complication of acute heroin use. Chronic ethanol use may have a "sensitizing" role in the pathogenesis of this syndrome.- - - - - - - - - - ranking = 6keywords = heroin (Clic here for more details about this article) |
4/243. Compartment syndrome of the hand following intra-arterial injection of heroin.We report two cases of compartment syndrome of the hand and forearm, due to intra-arterial injection of heroin, managed by surgical fasciotomies alone. We also review the literature on the management of this condition.- - - - - - - - - - ranking = 5keywords = heroin (Clic here for more details about this article) |
5/243. Sonography in the diagnosis of rhabdomyolysis.This case report describes the use of musculoskeletal sonography in the diagnosis of rhabdomyolysis. The case involved an episode of severe muscle lysis following a heroin overdose in an addict who lay comatose for an uncertain period. Sonography revealed multiple hyperechoic areas within the muscles examined, consistent with a recent injury. The clinical diagnosis of rhabdomyolysis may be difficult but is important in view of the attendant danger of acute renal failure, and sonography was instrumental in the diagnosis in this case.- - - - - - - - - - ranking = 1keywords = heroin (Clic here for more details about this article) |
6/243. Inhaled heroin-induced status asthmaticus: five cases and a review of the literature.We report five cases of status asthmaticus (four requiring mechanical ventilation) that were triggered by inhaled heroin and review the pertinent literature. These cases share common features of sudden and severe asthma exacerbations temporally related to heroin use, stress the importance of considering illicit drug use in like cases, and call attention to a public health issue.- - - - - - - - - - ranking = 6keywords = heroin (Clic here for more details about this article) |
7/243. Focal myopathy induced by chronic heroin injection is reversible.We report a patient who developed a focal myopathy with prominent contractures of his thigh muscles induced by chronic heroin injection. Muscle biopsy and magnetic resonance imaging (MRI) were indicative of a fibrotic and inflammatory process. Treatment with steroids, D-penicillamine, and physical therapy led to full functional recovery within 6 months. Sequential electromyographic (EMG) studies and muscle biopsies showed evidence of regenerating muscle fibers and absence of inflammatory cells. We conclude that heroin-induced focal myopathy is reversible and that combination therapy with D-penicillamine and steroids may be useful.- - - - - - - - - - ranking = 6keywords = heroin (Clic here for more details about this article) |
8/243. Unusual consequences of heroin overdose: rhabdomyolysis, acute renal failure, paraplegia and hypercalcaemia.A 29-yr-old man, known to be a heroin addict, was found at home totally unrousable, bent on his hips in the lotus position. On admission, he required frequent ventricular defibrillation, external pacing and infusion of calcium. A diagnosis of rhabdomyolysis caused by heroin and cocaine overdose was made. He developed paraplegia below T12, acute renal failure, acute compartment syndrome in one leg and a coagulation defect. Despite a fasciotomy, a through-knee amputation of the leg was required. Haemodialysis was required for 26 days, and this period was complicated by increased serum calcium concentrations, which was treated with disodium pamindrate. calcium deposits were palpable in the muscles and could be seen in vessels on limb x-rays. After 34 days, he was eventually discharged to a general surgical ward and subsequently into the community.- - - - - - - - - - ranking = 6keywords = heroin (Clic here for more details about this article) |
9/243. The spectrum of bacillus bacteremias in heroin addicts.bacillus bacteremias occurred in two heroin addicts. The first patient had one day of fever and chills after intravenous heroin use. Persistent cereus bacteremia consistent with endocarditis was documented and responded to four weeks of antibiotic therapy. The second patient had non-cereus bacillus species isolated from blood cultures three times over eight days, each time after renewed heroin use. The patient remained well, and the bacteremias cleared spontaneously. Because bacillus species frequently contaminate heroin injection materials and because the bacillus bacteremias were temporally associated with intravenous heroin use, bacillus bacteremias in both patients probably eventuated from heroin abuse. These cases, in conjunction with two previously reported cases of bacillus endocarditis in heroin addicts, suggest that heroin addicts are at risk for developing bacillus bacteremias, which may vary in severity from endocarditis to benign transient bacteremias.- - - - - - - - - - ranking = 12.2652522121keywords = heroin, heroin abuse, abuse (Clic here for more details about this article) |
10/243. anesthesia-assisted rapid opiate detoxification: a new procedure in the postanesthesia care unit.heroin detoxification by anesthesia-assisted rapid opiate detoxification (AAROD) can be achieved in approximately 1 hour using intravenous administration of midazolam, propofol, and naloxone. Opiate dependence and detoxification techniques are reviewed. Important aspects of patient care and perianesthesia nursing are described using a case study. To assist in caring for the patient undergoing anesthesia-assisted rapid opiate detoxification, the perianesthesia nurse should understand the methodology and controversy of this new procedure.- - - - - - - - - - ranking = 0.00070713269565284keywords = dependence (Clic here for more details about this article) |
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