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1/850. A case of gamma-hydroxybutyric acid withdrawal syndrome during alcohol addiction treatment: utility of diazepam administration.

    Gamma-hydroxybutyric acid (GHB) is an emerging drug for alcoholism therapy. We present a case of GHB withdrawal syndrome secondary to GHB addiction during alcoholism treatment. A complete disappearance of drug withdrawal syndrome was achieved with oral diazepam and the symptoms resolved without sequelae. GHB has been used for alcoholism therapy for only a few years now, but the trend is increasing, and other cases similar to this one are foreseeable. This risk could be higher in some countries in which GHB use is increasing not for alcoholism therapy, but for its euphoric and anabolic effects. The present experience indicates that administration of benzodiazepines would seem to be sufficient to achieve total regression of the withdrawal syndrome in a short time, at least if recognized early.
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ranking = 1
keywords = drug
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2/850. Severe panarteritis associated with drug abuse.

    A case of panarteritis with purpura fulminans, mononeuritis multiplex, gastrointestinal manifestation and presumably cardiac involvement in a previously healthy 22-year-old man with a history of drug abuse including cocaine, cannabinoids and methamphetamines is described. Histopathological examination of the gut led to the diagnosis of panarteritis without immune deposits. Antineutrophil antibodies were negative. Besides the drugs, no other possible cause of vasculitis was found. The patient recovered completely after 1 year. Drug abuse is a thus possible cause of severe extracerebral disabling vasculitis.
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ranking = 3
keywords = drug
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3/850. Pseudo-subarachnoid hemorrhage: a rare neuroimaging pitfall.

    OBJECTIVE: We report an unusual case of the CT appearance of diffuse subarachnoid hemorrhage in a patient with anoxic encephalopathy, a situation which neurosurgeons, neurologists, and neuroradiologists should be aware of. CLINICAL PRESENTATION: A young man collapsed unconscious in jail after abusing an unknown quantity and variety of drugs. CT scan showed a picture compatible with diffuse subarachnoid hemorrhage. INTERVENTION: As the patient had a Glasgow coma Score of 3 no heroic intervention was undertaken. An autopsy performed 40 hours after the initial ictus and 24 hours after death revealed no evidence of subarachnoid hemorrhage but gross and microscopic evidence of anoxic encephalopathy. CONCLUSION: Anoxic encephalopathy can mimic diffuse subarachnoid hemorrhage on CT.
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ranking = 0.5
keywords = drug
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4/850. Bleeding from self-administration of phenindione: a detailed case study.

    A young woman presented with a 2 year history of a severe bleeding disorder and marked deficiencies in all four vitamin-K-dependent factors. Metabolic studies with tracer doses of tritium-labelled vitamin K1 suggested that the patient might be taking an oral anticoagulant; and subsequently her plasma was found to contain a substance identical to phenindione in its spectrophotometric and chromatographic properties. The half-disappearance times of factors II, IX, X were measured after the administration of a concentrate of these factors and were found to conform with published figures. The concentrate controlled the patient's excessive bruising and prolonged skin and gingival bleeding. It would therefore seem that factor vii may not be essential in reversal of the bleeding disorder induced by anticoagulant overdose.
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ranking = 1.6617940936321
keywords = overdose
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5/850. tuberculosis treatment through directly observed therapy in a large multisite methadone maintenance treatment program: addressing the public health needs of a high-risk population.

    The rate of tuberculosis in patients receiving methadone treatment is significantly greater than the general population. The stabilization of former injection drug users occurs within methadone maintenance treatment programs, indicating the suitability of these sites for directly observed therapy (DOT). There are formidable barriers to the success of DOT, some are institutional, others patient-related. Strategies to address these obstacles need to be implemented. The integration of DOT into existing programs required support from the new york State Department of Health, institutional commitment, as well as continued staff and patient education and training.
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ranking = 0.5
keywords = drug
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6/850. Cardiovascular toxicity after ingestion of "herbal ecstacy".

    "Herbal Ecstacy" (sic) is an alternative drug of abuse usually containing both ephedrine and caffeine. Our literature search did not reveal any other reported cases of cardiovascular toxicity related to herbal "drugs of abuse." A case of cardiovascular toxicity following the ingestion of herbal ecstacy is presented. A 21-year-old male presented to the emergency department with an initial blood pressure of 220/110 mmHg and ventricular dysrhythmias after ingesting four capsules of herbal ecstacy. He was treated with lidocaine and sodium nitroprusside, and his symptoms resolved in 9 h. The pathophysiology and clinical course of ephedrine toxicity are discussed. Emergency physicians should consider ephedrine preparations in the differential diagnosis of patients presenting with a sympathomimetic toxidrome. Drugs of abuse containing "herbal" products can produce serious morbidity and mortality.
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ranking = 1
keywords = drug
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7/850. Drug-induced lung disease.

    Since there are no diagnostic studies to confirm the presence of a drug-induced lung reaction the physician will make a correct diagnosis only if he is aware of the drugs which have been identified to cause pulmonary reactions and their specific manifestations. Failure to recognize a drug-induced lung disease can lead to significant morbidity and in some cases mortality. The major drug-induced lung diseases are reviewed, the drugs being presented in the context of their clinical use and the reactions on the basis of common pathogenetic mechanisms.
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ranking = 2.5
keywords = drug
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8/850. 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.
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ranking = 0.5
keywords = drug
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9/850. Intravenous injection of talc-containing drugs intended for oral use. A cause of pulmonary granulomatosis and pulmonary hypertension.

    Clinical and morphologic features are described in two patients known to have repeatedly injected intravenously talc-containing drugs intended for oral use. In one patient severe pulmonary hypertension developed; the talc granulomas in him were located predominantly within the pulmonary arteries. The second patient had normal pulmonary arterial pressures, and the talc granulomas in him were located predominantly in the pulmonary interstitium. Of 19 previously described patients with pulmonary talc granulomas, 12 had morphologic evidence of pulmonary hypertension (in three of severe degree); in each, talc granulomas were located predominantly within the pulmonary arteries. In those without signs of pulmonary hypertension, granulomas were located predominantly in the pulmonary interstitium. Why there are differences in the distribution of the talc granulomas is unclear. It is clear, however, as demonstrated by one of our patients, that severe pulmonary hypertension may be a consequence of intravenous injection of drugs intended for oral use.
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ranking = 3
keywords = drug
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10/850. Toxic ingestion of gamma-hydroxybutyric acid.

    Gamma-hydroxybutyric acid (GHB) has become a popular new drug of abuse. Its effects include euphoria and disinhibition. Recently, several cases have been reported in the literature of life-threatening or lethal ingestions. We report the case of a 17-year-old male who became unresponsive after taking GHB. Gamma-hydroxybutyric acid is used outside the united states to treat narcolepsy. In the past, it was touted as a muscle-bulking aid and was taken by body-builders. It has also been implicated as a drug involved in "date-rapes." patients who ingest excessive GHB have a markedly altered level of consciousness, as did the patient in this illustrative case. neostigmine and physostigmine show promise as potential reversal agents. Gamma-hydroxybutyric acid overdose should be considered in any patient with altered mental status and a history of recreational drug abuse.
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ranking = 3.1617940936321
keywords = overdose, drug
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