| Following cryptococcal meningitis, symptoms of cervical syringomyelia developed in a young heroin addict. myelography confirmed syringomyelia and angiography demonstrated severe hydrocephalus. Ventriculoperitoneal shunting resulted in complete resolution of signs and symptoms of both hydrocephalus and syringomyelia. ( info) |
| OBJECTIVES: To estimate the effects of methadone programs in new south wales on mortality. DESIGN AND CASES: Retrospective, cross-sectional study of all 1994 new south wales coronial cases in which methadone was detected in postmortem specimens taken from the deceased. Cases were people we identified as patients in NSW methadone maintenance programs or those whose deaths involved methadone syrup diverted from maintenance programs. OUTCOME MEASURES: Relative risks of fatal, accidental drug toxicity in the first two weeks of treatment and later; the number of lives lost as a result of maintenance treatment; preadmission risks and the number of lives saved by maintenance programs, calculated from data from a previous study. RESULTS: There was very close agreement between this study's classifications and official pathology reports of accidental drug toxicity. The relative risk (RR) of fatal accidental drug toxicity for patients in the first two weeks of methadone maintenance was 6.7 times that of heroin addicts not in treatment (95% CI RR, 3.3-13.9) and 97.8 times that of patients who had been in maintenance more than two weeks (95% CI RR, 36.7-260.5). Despite 10 people dying from iatrogenic methadone toxicity and diverted methadone syrup being involved in 26 fatalities. In 1994, NSW maintenance programs are estimated to have saved 68 lives (adjusted 95% CI, 29-128). CONCLUSIONS: In 1994, untoward events associated with NSW methadone programs cost 36 lives in NSW. To reduce this mortality, doctors should carefully assess and closely monitor patients being admitted to methadone maintenance and limit the use of takeaway doses of methadone. ( info) |
| A 22-year-old man presented with acute swelling of the left neck and associated weakness of the left arm upon awakening after having snorted heroin. He had consumed large amounts of ethanol regularly for 7 years. serum creatine kinase was greater than 19,000 units/l. A diagnosis of focal rhabdomyolysis and left brachial plexopathy was made. Focal rhabdomyolysis with associated plexopathy is an uncommon but recognized complication of acute heroin use. Chronic ethanol use may have a "sensitizing" role in the pathogenesis of this syndrome. ( info) |
4/311. Intravenous injection of talc-containing drugs intended for oral use. A cause of pulmonary granulomatosis and pulmonary hypertension. Clinical and morphologic features are described in two patients known to have repeatedly injected intravenously talc-containing drugs intended for oral use. In one patient severe pulmonary hypertension developed; the talc granulomas in him were located predominantly within the pulmonary arteries. The second patient had normal pulmonary arterial pressures, and the talc granulomas in him were located predominantly in the pulmonary interstitium. Of 19 previously described patients with pulmonary talc granulomas, 12 had morphologic evidence of pulmonary hypertension (in three of severe degree); in each, talc granulomas were located predominantly within the pulmonary arteries. In those without signs of pulmonary hypertension, granulomas were located predominantly in the pulmonary interstitium. Why there are differences in the distribution of the talc granulomas is unclear. It is clear, however, as demonstrated by one of our patients, that severe pulmonary hypertension may be a consequence of intravenous injection of drugs intended for oral use. ( info) |
5/311. Compartment syndrome of the hand following intra-arterial injection of heroin. We report two cases of compartment syndrome of the hand and forearm, due to intra-arterial injection of heroin, managed by surgical fasciotomies alone. We also review the literature on the management of this condition. ( info) |
| This case report describes the use of musculoskeletal sonography in the diagnosis of rhabdomyolysis. The case involved an episode of severe muscle lysis following a heroin overdose in an addict who lay comatose for an uncertain period. Sonography revealed multiple hyperechoic areas within the muscles examined, consistent with a recent injury. The clinical diagnosis of rhabdomyolysis may be difficult but is important in view of the attendant danger of acute renal failure, and sonography was instrumental in the diagnosis in this case. ( info) |
7/311. 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. ( info) |
8/311. Serendipitous rapid detoxification from opiates: the importance of time-dependent processes. Opiate detoxification procedures aim to reduce intensity and duration of withdrawal. Ultra-rapid opiate detoxification (UROD) methods attempt to obtain this goal by administering naltrexone under deep sedation or anaesthesia. We present a case study on accidental ingestion of naltrexone in a methadone maintenance patient, which shows close methodological similarities with UROD procedures. naltrexone was effective in reducing withdrawal duration, but not as much as UROD studies report. The administration of naloxone after detoxification did not trigger withdrawal symptoms, even in the presence of methadone, as detected by urinalyses. These results suggest the importance of further developing detoxification methods based on protocols of administration of antagonists different from UROD, in absence of anaesthesia. ( info) |
9/311. Pneumomediastinum: the Valsalva crunch. The following case presentations illustrate the diverse clinical manifestations and benign self-limited course of spontaneous pneumomediastinum. The discussion includes the mechanisms involved, the symptoms, the radiographic findings, the potential complications, the exclusionary diagnosis, and the appropriate management of this condition. ( info) |
| We report five cases of status asthmaticus (four requiring mechanical ventilation) that were triggered by inhaled heroin and review the pertinent literature. These cases share common features of sudden and severe asthma exacerbations temporally related to heroin use, stress the importance of considering illicit drug use in like cases, and call attention to a public health issue. ( info) |