261/1862. Limb-body wall complex associated with cocaine abuse: further evidence of cocaine's teratogenicity. Limb-body wall complex is a complicated fetal malformation with the essential features of body wall disruption and limb abnormalities. Data from studies in the rat model suggest that vascular disruption is an etiology for limb-body wall complex. Because of its vasospastic properties, cocaine can act as a teratogen by impairing uteroplacental fetal blood flow during critical periods of development. We describe the prenatal detection of two fetuses with limb-body wall complex, whose mothers smoked large amounts of cocaine during the first trimester of pregnancy. Ultrasonographic evaluation of the fetus should be offered routinely in pregnancies complicated by maternal cocaine abuse. ( info) |
262/1862. Dilated cardiomyopathy associated with chronic overuse of an adrenaline inhaler. Endogenous catecholamines in excess are known to cause dilated cardiomyopathy. A patient presented with dilated cardiomyopathy after many years of overusing an adrenaline inhaler. Pathological features and a considerable improvement in myocardial function after withdrawal implicated the exogenous catecholamine excess in the pathogenesis of the cardiomyopathy. ( info) |
263/1862. Maltreatment in psychiatrically hospitalized dually diagnosed adolescent substance abusers. The medical charts of 150 consecutive admissions of dually diagnosed substance abusing adolescents admitted to a psychiatric hospital were examined to determine the extent and characteristics of maltreatment. Results indicated that 61% of the sample experienced or had a history that warranted suspicion of past and/or current maltreatment. Physical abuse was the most frequent form of maltreatment, followed by sexual abuse and neglect. Thirty-seven percent of patients experienced multiple forms of maltreatment. Maltreated patients had significantly more hospitalizations than their nonmaltreated counterparts on the same unit. Moreover, the age of maltreated patients was significantly lower than nonmaltreated patients, perhaps indicating an earlier age of onset of psychiatric illness and/or substance abuse. Analyses of parental substance abuse and psychiatric history among the maltreated and nonmaltreated groups revealed no significant findings. Results are discussed in terms of the following: (1) increased risk of subsequent substance abuse in maltreated children; (2) need for systematic assessment of child maltreatment in psychological or psychiatric evaluations; and (3) importance of treatment to deal with abuse or neglect as part of a comprehensive substance abuse intervention strategy. ( info) |
| neuroleptic malignant syndrome, a rare and potentially fatal complication of antipsychotic drugs, is poorly understood. Equally poorly understood are the risk factors of neuroleptic malignant syndrome. Long-term and parenteral treatment with high doses of neuroleptic drugs are implicated as risk factors for the syndrome. Recently, attention has been drawn to the frequency of neuroleptic malignant syndrome in patients treated with a combination of haloperidol and lithium. This article reports a case in which the patient's risk factors for neuroleptic malignant syndrome included not only haloperidol and lithium but also a predisposition to substances of abuse. ( info) |
265/1862. Effects of AIDS, cocaine, and family violence on children in out of home care. The medical practitioner encounters more medical and psychological illness in foster children than in the general population. The number and complexity of problems in foster children and their families has been increased by acquired immunodeficiency syndrome, cocaine, and family violence. Clinicians who are aware of the high rate of chronic medical problems in foster children will be prepared to diagnose, treat, and coordinate care and follow-up. It is helpful to understand the vulnerability of foster children to emotional disturbance both as a result of family dysfunction which necessitated placement and as a morbidity of the psychological stress of the crisis of placement with subsequent risk of deterioration in foster care. Practitioners' formal knowledge of the problems of foster children and of the structure of the child welfare system promotes appropriate patient care and better directed advocacy. ( info) |
| Three cases of disulfiram induced Parkinsonism and frontal lobe-like syndrome associated with bilateral lesions of the lentiform nuclei on CT scan are reported. Symptoms developed either after an acute high dose of disulfiram (one case) or after several days to weeks of disulfiram treatment (two cases) and persisted over several years in two patients. These observations suggest that basal ganglia are one of the major targets of disulfiram neurotoxicity. The mechanisms of the lesions of basal ganglia may involve carbon disulfide toxicity. ( info) |
| Serial MRI findings of changes in corpus callosum lesions in two cases of marchiafava-bignami disease are presented. In both, MRI displayed diffuse swelling of the corpus callosum in the acute stage, thought to represent oedema and demyelination. In the chronic stage, in addition to atrophy of the corpus callosum with presumed focal necrosis, previously undescribed focal hypointensity on T2-weighted images, of unknown cause, was observed in the corpus callosum. ( info) |
268/1862. Visceral infarction caused by cocaine abuse: a case report. cocaine abuse is now known to result in a wide variety of medical illnesses. We report our experience with one patient who had abdominal pain and was found to have near-total infarction of all abdominal viscera. The cause of this and other medical complications of cocaine abuse (i.e., extreme vasoconstriction) is discussed in detail. physicians should maintain a high index of suspicion when dealing with complaints of abdominal pain by cocaine users. ( info) |
269/1862. Magnetic resonance studies on brain dysfunction induced by organic solvents. A 38-year-old layer of parquet flooring was referred because of memory impairment, tiredness and diffuse headaches. His work involved using several neurotoxic organic solvents. Extensive laboratory, neuropsychological, clinical neurophysiological, neuroadiological, magnetic resonance (MR) imaging and spectroscopy studies were performed. The neuropsychological and behavioural assessments showed an organic brain syndrome. MR imaging and CT scanning of the brain revealed enlarged ventricles and generalized atrophy. 31P and 1H MR spectroscopic measurements did not show any abnormalities. Owing to recent improvements regarding sensitivity and facilitated assignment, MR spectroscopy may provide in the near future significant additional information on brain metabolism in patients with brain dysfunction presumably induced by organic solvents. ( info) |
270/1862. Sickle cell crisis and cocaine hepatotoxicity. Hepatic dysfunction occurs in up to 10% of patients with sickle cell crisis; however, hepatic failure is quite unusual. cocaine hepatotoxicity has recently been recognized in humans with liver biopsies showing varying patterns of necrosis. Most patients reported with cocaine intoxication have rhabdomyolysis with renal failure, and half of the cases have been fatal. A patient with concomitant sickle cell crisis and cocaine intoxication presented with hepatic failure, coagulopathy, and encephalopathy. Transjugular liver biopsy showed focal areas of confluent necrosis and large areas of collapse. cocaine intoxication should be considered in the differential diagnosis of hepatic failure in patients with sickle cell anemia. ( info) |