1/9. Acute ischaemic colitis following intravenous cocaine use.Intestinal ischaemia is an uncommon complication of recreational cocaine abuse. We report the case of a 36-year-old male who underwent emergency surgery for acute abdomen. At laparotomy, the transverse colon appeared markedly oedematous, dilated and with subserosal haemorrhage. Segmental resection was performed and microscopic examination of the resected specimen showed focal necrosis of the mucosa with a patchy polymorphonuclear and mononuclear infiltrate. The submucosa was markedly thickened due to oedema; focal haemorrhage was observed and blood vessels were dilated but showed no structural abnormalities or thrombosis. These findings were consistent with ischaemic colitis. No risk factors for intestinal ischaemia were present but the patient stated that he had injected cocaine i.v. the day before the onset of symptoms. He was not a cocaine abuser but occasionally sniffed, smoked or injected cocaine. cocaine use should be considered in the aetiological diagnosis of intestinal ischaemia in young patients.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/9. streptococcus milleri and complex groin abscesses in intravenous drug abusers.Intravenous drug abuse is an increasing problem. Septic complications occur frequently at the injection site, especially in the groin where large abscesses around the femoral vessels can threaten life or limb. We report four patients with extensive or complex groin abscesses following attempted self-injection into the femoral vein. streptococcus milleri was cultured from all of these abscesses and prompted a review of the isolation of this organism in this hospital.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/9. Severe arteriosclerosis in the kidney of a cocaine addict.cocaine abuse has been associated with sudden cardiac death with coronary artery thrombosis with or without underlying vessel disease. Additional vascular beds thus far implicated in cocaine-associated arteriopathy include thoracic and abdominal aorta, and pulmonary, cerebral, and placental vessels; abnormalities include vasospasm, thrombosis, and accelerated atherosclerosis. We report the case of an adult male cocaine user with severe arteriosclerosis of renal vessels, and suggest that cocaine may also affect the renal vasculature.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
4/9. Complications relating to intravenous buprenorphine abuse: a single institution case series.INTRODUCTION: We present a retrospective descriptive study of cases admitted to Tan Tock Seng Hospital from March 2005 to October 2005 with complications of Subutex abuse. CLINICAL PICTURE: A total of 8 patients were studied. Of the 8, 7 were male and one was female. Their complications consist of the following: arterial pseudoaneurysm (2), arterial pseudoaneurysm with infective venous thrombus (1), infective venous thrombus (1), venous thrombus (2), end arterial spasms (1) and sympathetic dystrophy (1). TREATMENT: For the patient who presented with buprenorphine-associated neuropathy, non-operative treatment with analgesics was given. Conservative medical therapy involving deep venous thrombosis treatment was instituted for the patient with deep venous thrombosis. Repair, restorative bypass and embolectomy surgery were performed for patients who had severe embolic/thrombotic complications. One of the patients who received the above surgery required amputation of his lower limb. OUTCOME: Of the 8 patients, 4 were treated medically, 3 required surgery and 1 required amputation. Their recoveries were uneventful. Of the 8, 1 absconded and was not followed up with. CONCLUSION: Parenteral injection of buprenorphine can cause a wide range of vascular complications from simple vascular irritation to severe infective thrombosis and pseudoaneurysms requiring limb amputations. Non-sterile preparation of an injected substance or non-sterile injection sites and the repeated punctures of major vessels are possible culprits in those who are seen to have acute infection of injection sites.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/9. biopsy-proven cerebral vasculitis associated with cocaine abuse.We report cerebral vasculitis in 2 cocaine users who developed symptoms (transient blindness and persistent headache) while smoking "crack," followed by progressive widespread cerebral dysfunction with focal signs over the next few weeks. One patient had smoked crack exclusively, and the other also used cocaine intravenously. Sedimentation rates were elevated and hiv titers negative. Arteriography was normal in 1 patient and in the other showed multiple large-vessel occlusions without beading. brain biopsy showed vasculitis involving small vessels in both patients. Multinucleated cells were present in the neuropil, but there were no granulomas or evidence of infection. One patient improved significantly with corticosteroid treatment, and made a good recovery. The other died despite corticosteroid and cyclophosphamide treatment.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
6/9. Pulmonary needle embolism from intravenous drug abuse.Although the embolization of catheters and other foreign bodies in blood vessels is a well-known happening, needle embolization has rarely been reported. We describe here an instance in which a hypodermic needle broke in a man's skin during cocaine injection. The needle fragment was observed to migrate within a short time to the periphery of the left lung. The patient did not develop complications. The limited literature available indicates that such peripheral embolization usually follows a benign course.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/9. Positive captopril renal scintigraphy in a patient with extensive bilateral renal interlobar arterial disease.The authors determined an unusual cause of renovascular hypertension in a 29-year-old man with the recent onset of hypertension and a history of intravenous substance abuse. captopril renal scintigraphy (CRS) demonstrated bilateral renogram changes and a decrease in estimated global glomerular filtration rate. The abdominal aortogram failed to show renal artery or branch artery stenosis. Magnified selective views of the kidneys demonstrated extensive, bilateral, small vessel interlobar disease. Two major points are illustrated in this patient. First, in the presence of positive CRS results and a history of renovascular hypertension, bilateral, selective, magnified renal angiography should be performed in accordance with standard abdominal aortic views when large vessel disease is not detected. Second, although surgical intervention is not an option in such patients, finding the cause of hypertension is important for patient management.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
8/9. Acute multifocal skin necrosis: synergism between invasive streptococcal infection and cocaine-induced tissue ischaemia?A 30-year-old pregnant woman with full thickness skin necrosis following parenteral abuse of cocaine and heroine is described. Three lesions occurred simultaneously on the trunk and right knee subsequent to an abscess on the left thigh from which S. pyogenes group A and S. aureus were isolated. histology revealed necrotic subcutaneous tissue with obliterated vessels and a mixed inflammatory infiltrate. The sequence of events suggests a synergism between the effects of bacterial proteases and cocaine-induced impairment of soft tissue perfusion. In the present case, this synergism may have been further enhanced by decreased cocaine tolerance during pregnancy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/9. necrobiosis lipoidica in a diabetic intravenous drug user.necrobiosis lipoidica occurs most commonly on the lower extremities in patients with diabetes; lesions typically occur in the pretibial region. Although the pathogenesis of necrobiosis lipoidica remains unclear, both external trauma and vascular damage have been proposed as contributing to the development of this disorder. We report polarizable foreign material in small blood vessels and multinucleated histiocytes in lesions of necrobiosis lipoidica. This phenomenon occurred in a patient who was both diabetic and an intravenous drug user.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |