1/141. 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 = discomfort, upper (Clic here for more details about this article) |
2/141. Youth living with hiv as peer leaders.Community-based service providers often hire youth living with hiv (YLH) as peer leaders for delivering hiv education to uninfected adolescents. life narratives were collected from 44 YLH during a hypotheses-generating two-year ethnographic study. About 30% of the youth were employed as peer educators. While 60% of the 44 youth had a lower-class background, only 23% of the peer leaders were lower class. One-fifth of the sample were female, but more than one-half of the peer leaders were female. After identifying and categorizing difficulties experienced by the peer leaders, a frequency count of each theme was conducted. Issues about professional boundaries were evident in 38.5% of the youth's narratives, indicating conflicts in their roles as peer leaders; 23% of the youth engaged in substance use and sexual behaviors that placed themselves and uninfected youth in their peer educator programs at risk; and 8% of the youth reported relapse while peer leaders. The observations suggest reconsideration or restructuring of existing peer-education models that employ YLH.- - - - - - - - - - ranking = 0.011323201048068keywords = back (Clic here for more details about this article) |
3/141. Upper aerodigestive tract frostbite complicating volatile substance abuse.Volatile substance abuse has become increasingly popular among today's youth. It has reportedly been used by up to 13% of teenage populations. physicians need to be aware of the potential complications which may arise from this form of substance abuse. We describe the case of a young male who presented with massive edema affecting his lips, oral cavity, oropharynx and trachea. It was later discovered that his injury was secondary to thermal trauma related to the abuse of a fluorinated hydrocarbon propellant. This presentation may easily be confused with allergic or angioneurotic edema. Denial by the patient can lead to a further delay in diagnosis. This case is especially notable since frostbite injury involving the upper aerodigestive tract is extremely rare. We discuss the differential diagnosis and the management principals required in the care of this patient. We also present a pertinent review of the literature related to both volatile substance abuse and its complications involving the airway.- - - - - - - - - - ranking = 0.04043560687729keywords = upper (Clic here for more details about this article) |
4/141. atrial fibrillation and anabolic steroids.A young male bodybuilder, consuming large doses of anabolic steroids (AS), presented to the Emergency Department (ED) with symptomatic rapid atrial fibrillation (AF). Echocardiogram revealed significant septal hypokinesis, and posterior and septal wall thickness at the upper limit of normal for highly trained athletes. The atrial fibrillation had not recurred at 10 weeks after discontinuation of AS use. Consumption of these agents in athletes has been associated with hypertension, ischemic heart disease, hypertrophic cardiomyopathy, and sudden death.- - - - - - - - - - ranking = 0.04043560687729keywords = upper (Clic here for more details about this article) |
5/141. Iatrogenic drug dependence--a problem in intensive care? Case study and literature review.Use of sedative and analgesic pharmacological agents is a widespread practice in intensive care units (ICUs). Mainly, this involves opioid and benzodiazepine analogues, both known to induce dependence/tolerance states. This paper is based on a clinical scenario in which a patient treated with these agents developed problems when they had been discontinued, and exploration of the extent of such problems generally. The problems range across a wide range of domains and may include physical discomfort, difficulty weaning from respiratory assistance and the drugs, and the problems of short- and long-term psychological distress. Although there may be a recognition that these drugs can typically cause dependence problems, little emphasis has traditionally been given to assessing these problems in ICUs. Yet the ICU may be an area where these drugs are used in high volumes. The recognition, physiology, management and prevention of iatrogenic drug dependence/tolerance in critical care environments is elucidated, with reference to relevant literature.- - - - - - - - - - ranking = 0.95956439312271keywords = discomfort (Clic here for more details about this article) |
6/141. Asphyxial death during prone restraint revisited: a report of 21 cases.Determining the cause of death when a restrained person suddenly dies is a problem for death investigators. Twenty-one cases of death during prone restraint are reported as examples of the common elements and range of variation in these apparently asphyxial events. A reasonable diagnosis of restraint asphyxia can usually be made after ruling out other causes and collecting supportive participant and witness statements in a timely fashion. Common elements in this syndrome include prone restraint with pressure on the upper torso; handcuffing, leg restraint, or hogtying; acute psychosis and agitation, often stimulant drug induced; physical exertion and struggle; and obesity. Establishing a temporal association between the restraint and the sudden loss of consciousness/death is critical to making a correct determination of cause of death.- - - - - - - - - - ranking = 0.04043560687729keywords = upper (Clic here for more details about this article) |
7/141. "Herbal Ecstasy": a case series of adverse reactions.AIMS: To report five cases of adverse effects associated with the ingestion of "Herbal Ecstasy" tablets and discuss possible mechanisms of toxicity. METHOD: Composition of the "Herbal Ecstasy" tablets was determined by discussions with distributors and with MEDSAFE: Reference to relevant texts and an internet and medline literature search was used to identify articles of interest RESULTS: Three patients complained of minor symptoms such as perceptual disturbances, anorexia, inability to sleep, dizziness, palpitations and paresthesia. A fourth patient presented with palpitations and ventricular bigeminy, and a fifth patient presented with headache, vomiting, and a hypertensive crisis. Different brands of "Herbal Ecstasy" have different compositions, some containing caffeine and kava, and one contained ephedrine. CONCLUSION: These five patients presented with adverse reactions to "Herbal Ecstasy" ranging from minor to major. knowledge of the possible mechanisms of toxicity will help plan therapy in cases of major toxicity.- - - - - - - - - - ranking = 2.401309080327keywords = headache (Clic here for more details about this article) |
8/141. Manifold manifestations of ergotism.Vasospastic side effects leading to organic manifestations are rare in ergotamine therapy. To our knowledge, combinations of more than two signs of ergotism have rarely been described in the literature so far. We present a 65-year-old male patient who as a consequence of severe migraine had developed ergotamine abuse. He was admitted to our hospital after one week of increasing abdominal pain. During laparotomy, necrotic areas of the small intestine and the sigmoid colon were resected, which on histopathologic examination revealed severe hypertrophy of the smooth musculature of mesenteric arteries, resulting from chronic vasospasms. Postoperatively, the patient developed ischaemia of the limbs which was confirmed by angiography. Before death, the patient also showed ischaemic signs in the acrae and necrosis of the tongue.- - - - - - - - - - ranking = 0.34497573478268keywords = abdominal pain (Clic here for more details about this article) |
9/141. toxicology of nutmeg abuse.BACKGROUND: Unpleasant and frightening side effects associated with the abuse of nutmeg occasionally generate emergency department referrals. We report a young patient's first-time experience with nutmeg and review the mechanisms of its toxicity. CASE REPORT: A 13-year-old female ingested 15-24 g of nutmeg over a 3-hour period and smoked and shared 2 joints of marijuana. To facilitate ingestion, the nutmeg was put into 00-000 gelatin capsules. Bizarre behavior and visual, auditory, and tactile hallucinations developed. She also experienced nausea, gagging, hot/cold sensations, and blurred vision followed by numbness, double, and "triple" vision, headache, and drowsiness. Nystagmus, muscle weakness, and ataxia were present. Her vital signs and laboratory tests were normal. She received 50 g of activated charcoal and except for complaints of dizziness and visual changes, her 2-day admission was uneventful. The central nervous system activity of nutmeg is often postulated to result from biotransformation of its chemical components to amphetamine-like compounds, but this has not been proven. Nutmeg contains several compounds with structural similarities to substances with known central nervous system neuromodulatory activity.- - - - - - - - - - ranking = 2.401309080327keywords = headache (Clic here for more details about this article) |
10/141. Project hope: changing care delivery for the substance abuse patient.Project hope is a program designed to assist healthcare providers in the assessment, care, referral, and follow-up of the hospitalized substance abuse patient. First implemented in 1990 at what is now called University Hospital in San Antonio, texas, the program has influenced care in a positive way through change in the attitude and knowledge of personnel, administrators, and community. In this paper, the authors provide an overview of the approaches utilized, improvement process, and outcomes obtained from this project. To formally evaluate the effectiveness of Project hope, a quasi-experimental, Solomon-Four design study was conducted. Eighty nurses from various educational backgrounds and experience with alcohol were divided into groups by nursing unit. A normative-reeducative intervention was applied as described by chin and Benne. Test of cognition showed significant change (p < .01) in the experimental group; no significance was found for attitudes change. Reasons for these findings and lessons learned from the process are described.- - - - - - - - - - ranking = 0.011323201048068keywords = back (Clic here for more details about this article) |
| | Next -> |