1/46. Acute pseudohepatitis in a chronic substance abuser secondary to occult seat belt injury.Causes of a massive elevation in serum aminotransferases (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) in the substance-abusing patient include viral hepatitis and drug hepatotoxicity. A patient chronically addicted to injection heroin and cocaine presented to the emergency room in a confused state and was admitted to a medical ward with an AST of 4120 U/L, ALT 3820 U/L and right upper quadrant discomfort. Investigations for viral and hepatotoxic causes for the liver dysfunction revealed only hepatitis c seropositivity. A computed tomogram of the abdomen, however, revealed a significant contusion to the right lobe of the liver consistent with traumatic injury. A motor vehicle accident, in which the patient was wearing a seat belt, and which had occurred a few days before admission and had been thought to be minor, was the cause of the liver dysfunction. Significant blunt abdominal traumatic injuries are usually managed exclusively by surgical trauma units. This case underlines the need for medical specialists to be aware of hepatic contusion injuries and to have a high index of suspicion when investigating unexplained hepatocellular dysfunction in chronic substance abusers who have been in motor vehicle accidents.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
2/46. Scopulariopsosis and hypersensitivity pneumonitis in an addict.Granulomatosis caused by fungal spores of a soil saprophyte is a newly recognized pulmonary complication of intravenous drug addiction. Brown, non-budding spores were histologically identified in necrotic tissue, inside giant cells of sarcoidlike granulomata, and in the vicinity of focal angiitic lesions. The fungus was identified by culture as the dematiaceous scopulariopsis brumptii. Cultural and histopathologic studies of lung biopsy specimens established the diagnosis. We showed precipitating antibodies to fungal antigen in the serum, prepared from the patient's isolate. Similar granulomatous pulmonary lesions were experimentally produced in mice by a single intravenous injection of spores of S. brumptii. The spores remained viable but did not show evidence of growth in the animal's tissue. Precipitating antibodies to fungal antigen and immediate wheal and late necrotizing type of skin reactions were shown in the challenged mice. The studies support the notion that pulmonary hypersensitivity to fungal spores was mediated by an Arthus'-type phenomenon.- - - - - - - - - - ranking = 0.021241420294783keywords = animal (Clic here for more details about this article) |
3/46. Viral hepatitis with intracytoplasmic cholestasis and cholesterol crystals in a drug addict.Electron-microscopical exammination of a liver biopsy from a young female drug addict with clinically relapsing serum hepatitis revealed virus-like particles free in the liver cell cytoplasm. In addition, there was intracellular cholestasis, and numerous clefts were found in the cytoplasm of hepatocytes, presumably caused by the presence of cholesterol crystals which were dissolved during the processing of the tissue. Such clefts have earlier been reported in liver cells in patients with cholestasis and hypercholesterolemia, but not in patients with viral hepatitis and a normal serum cholesterol concentration.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
4/46. Spontaneous bacterial peritonitis from streptococcus salivarius in a compromised host.A seriously ill patient with cirrhosis and resistant ascites from hepatitis c and alcohol abuse abruptly deteriorated. He developed encephalopathic changes, abdominal pain and tenderness and was suspected of having spontaneous bacterial peritonitis. The peritoneal fluid contained many granulocytes and Steptococcus salivarius was isolated from the fluid.- - - - - - - - - - ranking = 0.16666666666667keywords = hepatitis (Clic here for more details about this article) |
5/46. Novel cases: malingering by animal proxy.malingering to obtain medications of abuse is well documented in the general medical setting. However, we have found no cases previously reported of such malingering in a veterinary setting. We report five cases submitted by veterinarians in which clients (pet owners) are strongly suspected or confirmed to have been engaging in malingering to obtain controlled medications for their personal use. Cases bear a striking resemblance to malingering in the general medical setting for drugs to abuse. We propose that veterinarians, like their medical counterparts, are potential targets of malingering by their clients for drugs of abuse. Because of their familiarity with this condition, psychiatrists may have a role in training veterinarians to recognize malingering on the part of their human clients. In addition, psychiatrists may benefit from familiarizing themselves with novel forms of malingering, such as are presented in this case series.- - - - - - - - - - ranking = 0.084965681179134keywords = animal (Clic here for more details about this article) |
6/46. Acute hepatitis B and C virus coinfection: a virological and clinical study of 3 cases.We report the virological interaction in, clinical presentation of, and course of disease observed in 3 male injection drug users with acute hepatitis b virus (HBV) and hepatitis c virus (HCV) coinfection. In all 3 cases, HBV infection presented first and quickly resolved. diagnosis of acute HBV/HCV coinfection requires a long follow-up period with careful observation.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
7/46. methadone toxicity causing death in ten subjects starting on a methadone maintenance program.methadone maintenance therapy is designed to reduce the need for addicts to use heroin or other illegal opiates. death in patients starting on such a program has not previously been documented. We report the death of 10 persons who died within days of starting a methadone maintenance program administered by general practitioners. Their bodies were subject to a full autopsy by forensic pathologists, with a full toxicological examination. The mean starting dose had been 53 mg, which had been increased to a mean of 57 mg by the final dose. death occurred after a mean of 3 days. The mean blood methadone concentration at death was 2.1 mumol/L. Complete toxicological analysis showed that six subjects had additional drugs present including two with alcohol, two with benzodiazepines and morphine, and one with benzodiazepines alone. Pathological examination revealed the presence of chronic persistent hepatitis in all subjects and bronchopneumonia in five. The causes of death were given as methadone toxicity or methadone toxicity in combination with bronchopneumonia. Our observations highlight the dangers of methadone in the first days of starting on a maintenance program, particularly when the starting doses are relatively high and subjects have no demonstrated tolerance to opiates.- - - - - - - - - - ranking = 0.16666666666667keywords = hepatitis (Clic here for more details about this article) |
8/46. acute coronary syndrome and crystal methamphetamine use: a case series."Ice" is a form of methamphetamine commonly used as a recreational drug in hawaii and the philippines, but seldom encountered in the continental united states. It differs in appearance from methamphetamine tablets, but otherwise has exactly the same molecules, only arranged in a crystalline structure. A sizeable body of in vitro, animal, and autopsy data suggest a linkage between methamphetamine use and myocardial pathology. In this report, we describe a series of eight patients who developed unstable angina or acute myocardial infarction in association with smoking crystal methamphetamine. The findings, to a large extent, resemble those with cocaine-associated acute coronary syndromes. Given the widespread abuse of methamphetamine among young age groups, the recognition and primary prevention of cardiovascular toxic effects is of mounting socioeconomic importance.- - - - - - - - - - ranking = 0.021241420294783keywords = animal (Clic here for more details about this article) |
9/46. Major depressive disorder with psychotic features induced by interferon-alpha treatment for hepatitis c in a polydrug abuser.Infectious diseases, especially hepatitis c, are prevalent among drug abusers. interferon-alpha (IFN-alpha) is the pharmacological treatment of choice for this condition. patients being treated with IFN-alpha can be expected to experience such psychiatric side-effects as development of depression, mania, irritability, changes in personality, hallucinations or delirium. In addition, certain patients are considered to be at greater risk of developing neuropsychiatric side-effects. Individuals meeting the following criteria are particularly vulnerable: over 40 years of age; having central nervous system abnormalities; a previous neurological or psychiatric history; a past familial psychiatric history; use of narcotics or having alcohol or substance use disorders; being hiv-positive; coadministration of other cytokines; receiving high doses of IFN-alpha (> 6 million units). We report the case of a 29-year-old patient with chronic non-active hepatitis c, a previous psychiatric history of polydrug abuse (cannabis, heroin and illegal use of the psychotropic drug biperiden) and anxiety disorder. Two weeks after the initiation of IFN-alpha treatment, he developed fatigue, sleeplessness and persecutory delusions. The patient responded partially to the discontinuation of the IFN-alpha treatment. Due to the presence of three risk factors in this patient, he was considered to belong to the group of patients being 'at high risk' of developing neuropsychiatric side-effects. This is the first case report of major depressive disorder with psychotic features in such a 'high-risk patient'. This case report may prompt other research by showing the importance of the close monitoring, and the prevention of the progression of IFN-alpha-related psychiatric disorders in 'a high-risk patient'.- - - - - - - - - - ranking = 1keywords = hepatitis (Clic here for more details about this article) |
10/46. Psychiatric barriers to readiness for treatment for hepatitis c Virus (HCV) infection among injection drug users: clinical experience of an addiction psychiatrist in the hiv-HCV coinfection clinic of a public health hospital.Among injection drug users, psychological and psychiatric barriers to readiness for treatment for hepatitis c virus (HCV) infection include mood and anxiety disorders, cognitive deficits, temperament disorders, and personality vulnerabilities, as well as ongoing drug use. Many aspects of these barriers can be overcome with direct treatment or social support. To establish effective treatment for HCV infection in this population of patients, it is essential that the patient and providers develop a rapport that allows for active communication. It is also important that the patient make an effort to adhere to the treatment requirements and that the patient receive the appropriate evaluation and management of treatable barriers.- - - - - - - - - - ranking = 0.83333333333333keywords = hepatitis (Clic here for more details about this article) |
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