1/8. 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.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/8. Acute respiratory distress syndrome in a woman with heroin and methamphetamine misuse.methamphetamine, heroin, and cannabis are three of the most commonly misused drugs in asia. In taiwan, cases of misuse of methamphetamine have been increasing. In this paper, we report the case of a 23-year-old woman who had a 10-year history of smoking methamphetamine and intermittent use of heroin for 3 to 4 years. She developed pulmonary toxic effects associated with misuse of heroin and methamphetamine. She was brought to the emergency room because of consciousness disturbance and acute respiratory failure. Her symptoms of rapid progression of refractory hypoxemia, ill-defined densities over both lung fields, and normal pulmonary artery wedge pressure were consistent with acute respiratory distress syndrome. Rapid resolution of infiltrations and improvement of oxygenation were observed after mechanical ventilation with positive end-expiratory pressure support and oxygen therapy. She was discharged on the fifteenth hospital day without any sequela except for mild exertional dyspnea.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
3/8. Acute cardiomyopathy with recurrent pulmonary edema and hypotension following heroin overdosage.An 18-year-old man developed acute pulmonary edema following heroin overdose. Two days after initial improvement, there was recurrence of hypotension and pulmonary edema with severe hypoxemia refractory to mechanical ventilatory support utilizing positive and end-expiratory pressure. cardiac catheterization revealed elevated pulmonary capillary wedge pressure suggestive of left ventricular failure. The use of digitalis and diuretics resulted in prompt clinical improvement and ultimate recovery. Evidence is presented indicating that this patient represents an uncommon but important syndrome of acute cardiomyopathy with left ventricular failure which complicates the clinical course of certain cases of heroin overdose. Its physiologic diagnosis is of obvious importance in the choice of proper therapy, thereby increasing the patient's chances of recovery.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
4/8. Cardiovascular instability and baroreflex activity in a patient with tetanus.In a patient with tetanus we tested the hypothesis that the hyperadrenergic cardiovascular instability might be due to impairment of the baroreceptor reflex by the tetanus toxin. baroreflex sensitivity assessed with the phenylephrine method was found to be normal. Changes in arterial pressure correlated inversely with relative changes in plasma volume but not with plasma catecholamine levels. There were both extreme hypo- and hyper-adrenergic episodes. We conclude that sympathetic overactivity in tetanus temporarily overrules a functionally intact baroreflex leading to severe blood pressure instability with episodes of hypertension.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/8. Denial and split identity: timely issues in the psychoanalytic psychotherapy of compulsive drug users.Quite generally, psychotherapy and psychoanalysis are under great pressure today to account for what they are doing, to prove their scientific validity and their therapeutic efficacy. Those of us who use clinical experience in conducting their practice in ways which seem optimal, as judged both by them and by their patients, are increasingly challenged to respond to a canon of scientific method and validity that claims its brief for truth. What I am going to say will not live up to such high standards of proof, but will simply reflect my clinical experience: what helps and what fails with most patients that come to me, often after a string of previous treatment failures. What I am going to say claims practical usefulness, not ultimate scientific truth. I would like to highlight a number of issues that have proven themselves as of special importance for the long term treatment of substance abuse dependent patients. The first is the role various forms of denial play and how these might best be approached. Multiple layers of denial entail usually some form of split identity--rapid alternations from one part identity to the other. Then I shall briefly study the role of impulsivity and of various forms of impulsive action. These topics of denial, split identity and impulsive action dictate some reflexions on attitude and technique necessary for the long term psychotherapy of patients with prominent problems of substance abuse and impulsivity. I shall conclude with some more general recommendations for the future of psychotherapy with substance abusers.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/8. Elevated pulmonary capillary wedge pressure in a patient with hypovolemia.Since its introduction in 1969, the balloon-tipped pulmonary artery catheter has become widely accepted. Pulmonary capillary wedge pressures have been used diagnostically to determine left ventricular preload and volume status. We report on a patient with noncardiogenic pulmonary edema, secondary to a heroin overdose, who was hypovolemic and had an elevated pulmonary capillary wedge pressure. We discuss possible explanations and present evidence that the pulmonary capillary wedge pressure does not always accurately reflect volume status.- - - - - - - - - - ranking = 7keywords = pressure (Clic here for more details about this article) |
7/8. Malignant hypertension presenting as blurred vision in a 43 year old intravenous drug abuser.A 43 year old intravenous drug abuser presented to the accident and emergency department with a three week history of bilateral visual loss and frontal headaches. Fundoscopy revealed bilateral retinal cotton wool spots and haemorrhages and an ophthalmic opinion was requested. His blood pressure was subsequently found to be 210/140. A diagnosis of malignant hypertension was made and blood pressure was gradually controlled on oral antihypertensives. This case illustrates the importance of checking the blood pressure of all patients presenting with visual loss.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
8/8. Profound circulatory shock following heroin overdose.A 17-year-old previously healthy girl with profound circulatory shock following a heroin overdose is reported. Except for opiates no other substances and specifically no cocaine were found in the blood and urine samples. Even though the mechanism of shock is not completely understood, severe depression of left ventricular contractility seems to be the predominant reason. Acute right heart failure with decreased pulmonary capillary wedge pressure and arterial vasodilatation resulting in maldistribution of cardiac output cannot be ruled out as possible contributing factors. The shock was successfully reversed with volume loading and a high dose of dobutamine. The recovery was uneventful and the patient was discharged with normal cardiac function.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |