1/59. Pneumomediastinum: the Valsalva crunch. The following case presentations illustrate the diverse clinical manifestations and benign self-limited course of spontaneous pneumomediastinum. The discussion includes the mechanisms involved, the symptoms, the radiographic findings, the potential complications, the exclusionary diagnosis, and the appropriate management of this condition. ( info) |
2/59. Self perception affecting adherence to drug regimen following renal transplantation. The patient, a chronic cannabis user, found it increasingly difficult to tolerate the side effects of the medication on her appearance. Rejection in the early post-transplant period meant that immunosuppression could not be further reduced. We were able to avoid a catastrophic self-initiated cut in immunosuppression, and withdrawal of steroids was carried out according to a schedule supervised by the clinic. Cellular rejection resulted and was treated with i.v. methyl prednisolone and conversion from cyclosporin micro-emulsion (Neoral, Novartis) to tacrolimus (Prograf, Fujisawa) and from azathioprine to mycophenolate mofetil (CellCept, Roche). ( info) |
3/59. Traumatic brain injury, depression and cannabis use--assessing their effects on a cognitive performance. Patient RB is presented as a demonstration of the need for a more thorough understanding of the interactions of patient variables. RB had a history of traumatic brain injury along with current mood disorder and cannabis use. It was unclear initially whether or not his cognitive impairment was a permanent result of the brain injury, or a temporary effect of his mood and/or drug use. The literature offers few guidelines or precedents for understanding such complex cases or suggesting at which level it may be most appropriate to intervene. The impact of cannabis use in this individual appeared to have a detrimental effect on his mood. Treating RB's mood disorder resulted in larger cognitive gains than would have been anticipated in the literature. Specific neuropsychological tests are identified as being particularly sensitive to the cognitive changes in mood disorders. ( info) |
| We present the case of a 15-year-old with a cerebellar infarct that involved multiple arterial territories. It was temporally related to, and probably caused by, heavy marijuana use. While the mechanism of marijuana-associated stroke is unclear, the drug is known to cause hypotension and to impair peripheral vasomotor reflexes. We suspect that the child had diminished cerebral autoregulatory capacity and developed the stroke during a period of hypotension. ( info) |
5/59. Exogenous lipid pneumonia related to smoking weed oil following cadaveric renal transplantation. A 30-year-old female presented shortly after cadaveric renal transplantation with respiratory distress typical of a bacterial infection. Following initial improvement, she developed progressive respiratory failure, initially felt to be secondary to cytomegalovirus infection. Two bronchoalveolar lavages were nondiagnostic, and an open lung biopsy was performed, which revealed a pulmonary alveolar proteinosis (PAP) reaction and exogenous lipid pneumonia (ELP). The ELP was considered to be secondary to the use of marijuana, in the form of weed oil, that was smoked daily for over 10 years and stopped just before renal transplantation. This is the first description of both PAP and ELP following renal transplantation, and the first description of ELP related to smoking weed oil. physicians should be aware of the different forms of marijuana available and of their potential medical complications. ( info) |
| Should a person with history of drug addiction be categorically denied as a bone marrow donor? The answer to the question is controversial. We report a case of allogeneic bone marrow transplantation for refractory acute myeloid leukemia preceded by essential thrombocythemia. The donor used cocaine and marijuana the night before the bone marrow harvest. ( info) |
7/59. Marijuana: a decade and a half later, still a crude drug with underappreciated toxicity. In 1984, I published in this journal a review entitled "Marijuana: A Crude Drug With a Spectrum of Underappreciated Toxicity." In the introduction to that article, I disclosed that our son Keith, who was 15 years old at the time, was in a long-term, modified outpatient adolescent drug and alcohol rehabilitation program because he had become dependent on marijuana with its associated behavioral, interpersonal, scholastic, and antisocial problems. Keith and most of his friends had experimented several times with LSD, beer, and several other drugs but never used injection drugs. Marijuana was clearly Keith's drug of choice and the only drug he used with regularity. Approximately 1 year later, Keith graduated from the treatment program. He completed the early aftercare component, relapsed several times, and completed a 4-month refresher drug rehabilitation program in another state. Nine years after admission to the first rehabilitation program, Keith finally attained some adult goals. Now 34 years old, he has been drug-free for 10 years. He is the president and owner of a successful discount cellular phone business that he started. More important, a decade ago, he reestablished an excellent and close relationship with his parents. As far as I can tell, Keith remains drug-free except for an occasional beer. ( info) |
8/59. Psychosis and pregnancy: five cases of severely ill women. An increasing number of patients with chronic mental disease are now integrated in society. As a consequence, women with severe psychiatric illness may become pregnant and wish to complete the pregnancy and to give birth to a child. The lack of sensation of reality in these patients and their social situation may result in particular problems in their treatment, and it may be necessary to admit them to a psychiatric ward before delivery. In this paper five cases of pregnant women with severe and chronic psychosis are described. These patients had many problems in common. Thus, they were all schizophrenics with very severe psychopathology, had poor understanding of their own situation, and lacked social networks. All the fathers were non-Danish. coercion was used in all cases. To help women with severe mental illness to go through pregnancy and childbirth requires close collaboration between psychiatric and obstetric staff and social workers, and this should be organized in an institution with experience in the treatment of this type of patient. ( info) |
| The combination of bladder exstrophy and gastroschisis has not been reported previously. The authors describe this rare combination of congenital anomalies, as well as the successful multidisciplinary management of this unusual problem. ( info) |
| BACKGROUND: Tetrahydrocannabinol (cannabis) and lysergic acid diethylamide (LSD) are psychomimetic agents that induce impairment of sensory perception. illusions and hallucinations are mostly visual. Most frequently the visual phenomena occur in conjunction with drug abuse. patients AND methods: Three previously drug-addicted patients were examined for either persisting or spontaneously recurrent visual phenomena. Two patients complained of persisting visual illusions (vibrations, dyskinetopsia and impaired depth perception) during more than 12 months after an excessive use of cannabis. The third patient was a multiple drug abuser (LSD for 6 years) and complained of visual hallucinations and palinopsia following heavy ethanol intake, 20 years after stopping the use of any drug. RESULTS: Results from neuro-ophthalmic and neurological examinations were normal for the first two patients. The third patient presented abnormal visual fields with preserved visual acuity; electroencephalography was abnormal, suggesting an underlying toxic encephalopathy. CONCLUSIONS: Persistent visual illusions or hallucinations can occur during several months after an intake of cannabis. Flash-back phenomena are frequent amongst LSD abusers. They rarely occur at long times after the last intake (20 years in the present case); when they do so, precipitating factors are often present (ethanol, medication, anesthesia). Such phenomena reflect the cortical dysfunctions that can be induced by illegal substances. ( info) |