1/14. Focal myopathy induced by chronic heroin injection is reversible.We report a patient who developed a focal myopathy with prominent contractures of his thigh muscles induced by chronic heroin injection. Muscle biopsy and magnetic resonance imaging (MRI) were indicative of a fibrotic and inflammatory process. Treatment with steroids, D-penicillamine, and physical therapy led to full functional recovery within 6 months. Sequential electromyographic (EMG) studies and muscle biopsies showed evidence of regenerating muscle fibers and absence of inflammatory cells. We conclude that heroin-induced focal myopathy is reversible and that combination therapy with D-penicillamine and steroids may be useful.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/14. Disciplining addictions: the bio-politics of methadone and heroin in the united states.Biomedical understanding of methadone as a magic-bullet pharmacological block to the euphoric effects of heroin is inconsistent with epidemiological and clinical data. An ethnographic perspective on the ways street-based heroin addicts experience methadone reveals the quagmire of power relations that shape drug treatment in the united states. The phenomenon of the methadone clinic is an unhappy compromise between competing discourses: A criminalizing morality versus a medicalizing model of addiction-as-a-brain-disease. Treatment in this context becomes a hostile exercise in disciplining the unruly misuses of pleasure and in controlling economically unproductive bodies. Most of the biomedical and epidemiological research literature on methadone obscures these power dynamics by technocratically debating dosage titrations in a social vacuum. A foucaultian critique of the interplay between power and knowledge might dismiss debates over the Swiss experiments with heroin prescription as merely one more version of biopower disciplining unworthy bodies. Foucault's ill-defined concept of the specific intellectual as someone who confronts power relations on a practical technical level, however, suggests there can be a role for political as well as theoretical engagement with debates in the field of applied substance abuse treatment. Meanwhile, too many heroin addicts who are prescribed methadone in the united states suffer negative side effects that range from an accentuated craving for polydrug abuse to a paralyzing sense of impotence and physical and emotional discomfort.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/14. Misuse and abuse of diazepam: an increasingly common medical problem.Misuse and abuse of diazepam among addiction-prone individuals is reported. The most common pattern of abuse appears to be periodic ingestion of 30 to 80 mg of diazepam in one dose, either alone or in conjunction with methadone or other narcotics. Two cases of physical dependency to diazepam have been observed. Many addict patients using diazepam are buying it on "the streets". All physicians should know that diazepam abuse and misuse is occurring, and careful attention should be given to prescribing, transporting and storing this drug.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/14. Presentation, diagnosis, and management of arterial mycotic pseudoaneurysms in injection drug users.Injection drug users frequently present with abscess, cellulitis, and endocarditis. The development of arterial mycotic pseudoaneurysm (AMP) as a sequela of injection drug use, however, is much less frequently reported. We undertook a study to determine the prevalence and presenting clinical characteristics of AMP, utilizing a retrospective review of all emergency department cases seen at one city public hospital for the 5-year period 1994-1999. Initial evaluation included physical examination, CT scan, ultrasound, and/or angiography. There were 7,795 patient visits for complications of injection drug use; 11 patients had AMP (0.14%). AMP involved the brachial (n = 5), subclavian (n = 2), radial (n = 2), femoral (n = 1) and popliteal arteries (n = 1). fever was absent in the majority of patients (7/11). Either pulsatility or a mass was noted in three cases, and both were seen in 6/11 (54%). AMP was not initially suspected in three cases, which were treated as abscesses and surgically incised, resulting in arterial rupture. The annual prevalence of AMP in the presenting population was estimated to be 0.03%. However, a high index of suspicion for AMP should be maintained with injection drug users presenting with a mass or pulsatility over an artery, as there is risk of rupture, rapid exsanguination, and distal embolization.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/14. Treatment issues for opioid-dependent women during the perinatal period.Opioid dependence has been studied with regard to its effects on the woman, the fetus, and the child for the past three decades, and it continues to be a serious problem that must be recognized and addressed by the health care delivery system in order to provide optimal medical care. The use of pharmacotherapy, such as methadone maintenance treatment (MMT), is only one of a variety of treatment modalities to provide optimal services for opioid-dependent women. The complete schema for treating opioid dependence in the perinatal period is complex and intense, but MMT serves multiple purposes. Primarily, it removes the addicted woman from the drug-seeking environment, eliminates the necessary illicit behavior, and prevents the peaks and valleys in the maternal heroin level that may occur throughout the day. In addition, maternal nutrition is usually improved and MMT patients become amenable to prenatal care and psychosocial rehabilitation. It is evident from the findings of numerous studies that when the physical, psychological, and socioeconomic issues of pregnant opioid-dependent women and their children are coupled with MMT, the potential physical and behavioral effects of psychoactive drugs on the mother, the fetus, the newborn, and the child may be markedly reduced.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
6/14. candida endophthalmitis after intravenous drug abuse.patients with endogenous candida endophthalmitis associated with intravenous (IV) drug abuse may manifest ocular and systemic signs different from those seen in other forms of endogenous candida endophthalmitis. There may be a sparcity of evidence of systemic candidiasis, including negative serology and normal physical examination results. Anterior uveitis and extensive vitreous involvement are common and do not necessarily have associated typical retinal lesions, which are more commonly seen in the compromised host. This may occur either because of the more transitory nature of choroidal or retinal lesions or because these patients often seek treatment at later stages. Even with a typical clinical picture, it is difficult to get culture confirmation of the diagnosis. Material obtained by vitrectomy must be concentrated before inoculation of media because of the known difficulty of culturing candida from the vitreous cavity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/14. Inapparent pulmonary vascular disease in an ex-heroin user.A severe pulmonary vascular derangement, usually reported in drug addicts, was diagnosed in a 28-year-old asymptomatic ex-heroin user by means of fortuitously performed pulmonary perfusion imaging. Neither physical findings nor pulmonary function tests, aroused suspicion of the diagnosis. A search for asymptomatic pulmonary vascular disease probably should be undertaken in drug addicts.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/14. haemophilus parainfluenzae mitral valve vegetation without hemodynamic abnormality. Demonstration by angiography and serial echocardiography.The occurrence of haemophilus parainfluenzae endocarditis on a previously normal mitral valve of a drug addict is described. A large mitral valve vegetation was demonstrated by serial echocardiography and cineangiography. The vegetation did not produce hemodynamic abnormalities preventing detection by physical examination. Multiple septic emboli to various organs, including brain, resulted in death. The role of serial echocardiography and the levophase of right heart cineangiography in detecting mitral valve vegetation in a patient suspected of having infective endocarditis is emphasized.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/14. Spontaneous bilateral pneumothorax in drug addicts.Two cases of bilateral pneumothorax are reported in drug addicts; only one such case has been previously reported. They presented ostensibly as spontaneous pneumothoraces; however, meticulous history and physical examination proved them to be traumatic. Causes of spontaneous pneumothoraces are presented. Self-injection must be considered in the clinical differential diagnosis of spontaneous pneumothorax.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/14. heroin addict responses to six weeks of detoxification with LAAM.This paper describes the range of experience of 28 heroin addicts who received LAAM instead of methadone over six weeks in an outpatient detoxification program. Four patients are singled out to illustrate the variety of response during withdrawal, temporary abstinence from drugs, and social adjustment. The paper explores the motivation of patients and both their physical and subjective responses to the detoxification attempt. By describing a variety of patients, the paper documents clinical responses that cannot be communicated in statistical summaries or single-case reports. overall, the cases illustrate the difficulties of brief-stay outpatient detoxification from heroin. Clinicians should expect to see only small steps toward rehabilitation during a patient's attempt to taper from opiates, but even minimal progress may justify the use of detoxification programs as a link between "street life" and the decision to enter long-term treatment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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