1/30. Working and "drugging" in the city: economics and substance use in a sample of working addicts.employment status is often treated as a "risk factor" in epidemiologic studies of drug use. The process that underlies the supposed relationship has remained, however, essentially unexamined. This article uses life history data to look at the relationship between work and drug use in a sample of addicts from baltimore City, maryland. The narratives constructed by these individuals demonstrate that the processes involved in creating and maintaining drug- and nondrug-related identities are neither linear nor straightforward. Rather, managing complex, emergent identities is a product of the economic situation, the organization of the drug scene, and the larger milieu in which these addicts operate.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/30. Serratia arthritis in heroin users.Septic arthritis due to Serratia species was seen in four users of intravenous heroin. In all cases, the organism was cultured from joint aspirates. Both the clinical presentation and the involvement of the sacro-iliac and knee joints were notably similar to the pseudomonas septic arthritis encountered in other heroin users. All four patients responded satisfactorily to therapy although one had a residual flexion contracture of the knee. Twelve previously reported cases of Serratia arthritis are reviewed.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
3/30. Native valve endocarditis due to pichia ohmeri.candida species can cause clinical manifestations in various organs of the cardiovascular system, i.e., the pericardium, myocardium, and endocardium, with endocarditis being the best-known clinical entity. endocarditis is seen primarily in intravenous drug users and in individuals with damaged native valves, especially in congenital heart disease or rheumatic valvular diseases, and in prosthetic heart valves. The authors present a case of pichia ohmeri endocarditis in an intravenous drug user, with an unusual presentation form. This is a case of a 42-year-old man, an intravenous heroin user, who was admitted to our Vascular Surgery Department because of fever and acute serious ischemia of the left inferior limb. He presented with fever (39 degrees C), a pale and cold left limb, absence of the left popliteal pulse, and a pansystolic murmur at the cardiac apex. The transthoracic echocardiogram showed a large vegetation on the anterior leaflet of the mitral valve and severe mitral regurgitation with good left ventricular systolic function. Empirical antibiotic therapy was started. Six days after admission, embolectomy was performed with partial clinical recovery. Three blood cultures and the embolus showed a teleomorphic form of candida guilliermondii - pichia ohmeri. Therapy with intravenous liposomal amphotericin b, fluocitosin, imipenem, and aztreonam was started. Two weeks later, his clinical condition deteriorated with acute heart failure refractory to medical therapy, mandating mechanical ventilation and high-dose vasopressor and inotropic amine support. He underwent urgent mitral valve replacement with a biologic prosthetic valve. Rapid stabilization of the cardiac status occurred, but ischemic limb lesions required further vascular interventions.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
4/30. Intravenous paraquat poisoning-induced multiple organ failure and fatality--a report of two cases.paraquat poisoning is the most common cause of fatal herbicide intoxication, mostly through oral ingestion. This work reports two cases of death following intravenous paraquat injection. The clinical courses of the two cases were fulminated and fatal. Toxic symptoms and severe organ function impairment developed soon after paraquat injection. Timely treatment with activated charcoal hemoperfusion with pulse steroid and cyclophosphamide was attempted in both cases; however, both cases died within five days owing to multiple organ failure. In cases of intravenous paraquat intoxication, toxic signs develop more quicker than with oral ingestion. The prognosis of intravenous paraquat intoxication is extremely poor.- - - - - - - - - - ranking = 6keywords = organ (Clic here for more details about this article) |
5/30. Severe uncontrolled pain in buttock in a patient on naltrexone: a diagnostic challenge.A 26-year-old woman with a history of intravenous drug use was admitted to hospital with worsening pain in the right buttock radiating to the lateral part of the thigh and to the calf with no suspicion of cauda equina compression. Eventually, a diagnosis of sacroiliitis was made and appropriate antibiotics were administered. Provision of analgesia for this patient was difficult. On admission her medications included naltrexone, venlafaxine and tramadol. Initially naltrexone was continued and analgesia provided by epidural local anaesthetic and clonidine, intravenous ketamine and oral agents. After several days, naltrexone was ceased and opioids were used in addition to the other analgesics. The epidural analgesia was only partially effective, perhaps because of inadequate blockade of the L4-S1 nerve roots, which carry sensation from the sacroiliac joint. naltrexone is a long-acting opioid antagonist. If opioid analgesia is planned, it is necessary to cease naltrexone for 24 to 72 hours. In an emergency, if non-opioid techniques prove ineffective, short-acting opioids can be titrated to effect in a monitored environment.- - - - - - - - - - ranking = 1.0261116611784keywords = nerve (Clic here for more details about this article) |
6/30. A rare differential diagnosis in dysphagia: wound botulism.The incidence of wound botulism is increasing dramatically among intravenous drug users. Efficient intensive care and early treatment with antitoxin is essential to avoid lethal courses. The clinical picture of botulism is of descending, symmetric, flaccid paralysis. Early symptoms include cranial nerve palsies resulting in blurred vision and diplopia, difficulty in focusing, ptosis, facial weakness, dysphagia, dysphonia, and dysarthria. Because patients presenting with dysarthria and dysphagia will often be seen by an ear, nose and throat specialist initially, this rare but upcoming neurologic disease must be considered in the differential diagnoses.- - - - - - - - - - ranking = 1.0261116611784keywords = nerve (Clic here for more details about this article) |
7/30. hiv, heroin and heterosexual relations.This ethnographic study describes part of the social context in which heterosexual transmission of the human immunodeficiency virus (hiv) may be taking place. Based on interviews with sex partners of intravenous (IV) drug users in an urban, African American community of the united states, the study documents the personal experience of 35 men and women to show how living with one's own and/or one's partner's heroin habit may structure one's response to public health information and one's possibility of becoming infected with hiv. As described by sex partners of intravenous drug users, people who use heroin habitually are drawn into social networks that are loosely organized according to their preferred route of drug administration, i.e. 'shooters' (intravenous) and 'tooters' (intranasal), both of which tend to exclude 'squares' (non-use). Social divisions such as these may slow rates of hiv transmission to those outside the drug life. But nevertheless, as sex partners explain, there are many types of social and sexual exchanges taking place among shooters, tooters and squares, including but not limited to the exchange of bodily fluids. Ethnography analyzes discursive representations of such exchanges, filling in and questioning the empty categories of epidemiological prediction. How does risky behavior actually figure in the lives of individuals who happen to fall in the category of 'sex partner'? How is sexual behavior shaped by drug use behavior? Being sexually involved with an IV drug user for some years alters a person's relative position betwixt and between the drug subculture, on the one hand, and mainstream pursuits of family, work and church, on the other. Differences in personal need and group identity create conflicts. Couples in long-term relationships develop rules to manage these. But in which terms will they interpret and negotiate the new threat of AIDS? If the strategic aspect of discursive representations of experience is taken into account, and if discursive representations are interpreted within appropriate social and historical contexts, they can provide a rich source of material for understanding the social impact of the AIDS epidemic. Without this discursive dimension, analytic power to interpret seroprevalence data cross-culturally would be lacking. In addition, and independently of the problem of interpreting seroprevalence data, ethnographic analysis links local, culturally-specific meanings through which AIDS is interpreted to our understanding of AIDS as a global phenomena.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
8/30. From basic concepts to clinical reality. Unresolved issues in the diagnosis of dependence.This chapter discusses clinical and conceptual issues pertaining to the diagnosis of alcohol and drug dependence. Emphasis is given to the difficulties involved in moving from diagnostic concepts, such as those contained in the major psychiatric classification systems, to the clinical situation where diagnostic decisions are made. To illustrate how diagnostic concepts approximate clinical reality, a set of case histories is used to organize a discussion of unresolved issues in the diagnosis of dependence. These issues include the putative syndrome nature of dependence, the problem of diagnosing polysubstance use, the primary-secondary distinction, the presence of other psychopathology, and the use of multiaxial evaluation.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
9/30. serratia marcescens arthritis in heroin addicts.Serratia appears as a pathogen of increasing frequency and clinical significance in bone and joint infections in heroin users. This is the fifth case report of septic arthritis due to serratia marcescens in intravenous heroin users. The clinical and laboratory features were not different from other acute pyogenic arthritides. Signs of infection were obscure even in the presence of debilitating disease. Although pseudomonas and staphylococcus are more common organism in bone and joint infections of heroin users, Serratia should be considered as a possible pathogen in such patients. In the present case, immediate open drainage followed by systemic Gentamicin treatment gave rapid relief of pain and restoration of full range of motion of the joint.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
10/30. Radiological and neurological changes in the drug abuse patient: a study with MRI.Chronic abuse of drugs may lead to pathological changes within the nervous system. In this article we present the neurological and magnetic resonance imaging (MRI) findings in a group of seven drug abuse patients. The MRI for three of the patients showed areas of demyelination in white matter. Of the four patients with normal MRI, two showed seventh nerve paresis, one showed abnormal cerebral blood flow when measured with Positron Emission tomography and one patient had no evidence of neurological impairment. We hypothesize that some of the neurologic and psychiatric complications of drug abuse may be due to its effects on the cerebral circulation.- - - - - - - - - - ranking = 1.0261116611784keywords = nerve (Clic here for more details about this article) |
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