buprenorphine and Necrosis

Topics: Adult; Buprenorphine; Female; France; Humans; Injections; Male; Middle Aged; Narcotic Antagonists; Necrosis; Nicolau Syndrome; Opiate Substitution Treatment; Opioid-Related Disorders; Prospective Studies; Skin; Young Adult

The link between nasal inhalation of cocaine and nasal and palatal necrosis is well documented. In contrast, few data are available concerning nasal mucosa necrosis related to heroin snorting. The authors report here the retrospective analysis of 24 cases of orofacial lesions in patients with nasal heroin usage, collected between 2006 and 2012.. The cases concern 17 males and 7 females (median age 29.5 (range: 24-42)) with chronic consumption of intranasal heroin (from 2 months to more than 10 years). Six patients had a history of cocaine abuse. The median daily amount of heroin consumption was 5 g (range: 0.5-10). The complications were nasal perforation (11 cases), nasal ulceration or erythema (5 cases), nasal septum necrosis (5 cases), pharyngeal ulceration (3 cases), and palate damages (5 cases). The most common clinical signs and symptoms were nasal pain, purulent sputum, dysphagia, and rhinitis. Maintenance therapy with methadone (19 cases) or buprenorphine (3 cases) was initiated. In 8 cases, the injury improved.. The potential of heroin to induce destructive orofacial lesions should be considered when nasal damages are observed in patients with drug abuse. A multidisciplinary approach seems to be the most effective means of managing such patients.

Topics: Administration, Intranasal; Adult; Buprenorphine; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; Necrosis; Nose; Opiate Substitution Treatment; Palate, Soft; Pharynx

Necrosis of the penis glans is commonly described after circumcision or strangulation. We report the case of a patient, opioid abuser, who presented an isolated glans necrosis after an injection of buprenorphin. The buprenorphin (Subutex) is a sublingual partial mu-opioid agonist used for the treatment of heroin dependance. Its intravenous or subcutaneous abuse is associated with local infection. The patient require a surgical intervention. After the failure of a mucosal graft, a soft skin graft was done.

Topics: Adult; Buprenorphine; Cocaine-Related Disorders; Follow-Up Studies; Heroin Dependence; Humans; Injections, Subcutaneous; Male; Narcotic Antagonists; Necrosis; Penis; Reoperation; Skin Transplantation; Surgical Wound Infection; Wound Healing

Topics: Adult; Buprenorphine; Female; Humans; Injections, Intra-Arterial; Livedo Reticularis; Narcotics; Necrosis; Opioid-Related Disorders

Topics: Adult; Analgesics, Opioid; Buprenorphine; Humans; Injections, Subcutaneous; Male; Necrosis; Opioid-Related Disorders; Penis; Scrotum; Skin Diseases, Bacterial; Skin Ulcer; Streptococcal Infections; Streptococcus

Skin biopsies were performed in a patient with livedoid and necrotic lesions of the forearm. Periodic acid-Schiff-stained and birefringent Maltese cross-patterned foreign bodies were observed in capillary vessels. It was consistent with the diagnosis of intra-arterial injections of a substance containing corn starch. This finding confirmed the clinical diagnosis of intra-arterial injection of solubilized tablets of buprenorphine. This case constitutes a rare clinical presentation of foreign bodies injections in a drug addict.

Topics: Adult; Biopsy; Buprenorphine; Foreign Bodies; Humans; Injections, Intra-Arterial; Male; Narcotic Antagonists; Necrosis; Skin; Skin Diseases, Vascular; Substance-Related Disorders

Use of buprenorphine (Subutex) is widely used as substitution treatment in opiate addiction although its side-effects are little known. We report a case of localised necrotic livedo subsequent to injection of Subutex.. A 34 year-old male drug addict on Subutex substitution treatment presented a necrotic livedo and an ulcer with clearly demarcated edges on the skin of the inner elbow. Histological analysis revealed PAS-positive particles in a hypodermic inflammatory lymphohistiocytic infiltrate that were reflective and formed a Maltese cross under polarised light and were identified as maize starch.. This clinical case describes necrotic livedo lesions induced by injection of Subutex. The underlying mechanisms are associated with maize starch, an excipient used in Subutex. Unauthorised subcutaneous injection of buprenorphine (Subutex) is common among drug addicts but there is little description of the associated complications. In our patient, the presence in cutaneous biopsy samples of maize starch, an excipient of buprenorphine, provides evidence of intravenous administration of this drug.

Topics: Adult; Buprenorphine; Excipients; Humans; Injections, Subcutaneous; Male; Narcotics; Necrosis; Skin Diseases, Vascular; Starch; Substance Abuse, Intravenous

Topics: Adult; Buprenorphine; Female; Hand Dermatoses; Humans; Injections, Intra-Arterial; Male; Narcotics; Necrosis; Skin Diseases; Substance Abuse, Intravenous

In May 2002 Buprenorphine (Subutex) was listed on the Australian Pharmaceutical Benefits Schedule for treatment in opioid dependence. In addition to broadening treatment options, buprenorphine has the advantage of an improved safety profile. The risk of overdose is lessened but other risks remain due to diversion. French experience reports widespread deviation of buprenorphine sublingual tablets to intravenous injection. We report a case of attempted parenteral administration of buprenorphine tablets. Stringent protocols for dispensing are appropriate.

Topics: Adult; Analgesics, Opioid; Buprenorphine; Female; Groin; Humans; Necrosis; Skin Transplantation; Substance Abuse, Intravenous

To assess the effect on tracheal graft preservation of perfusion of donor tissue with a Collins solution before extraction and immunosuppression of the recipient. An experimental study was performed in 36 albino rabbits with revascularized heterotopic cervical reconstruction of the trachea with omentum. The animals were distributed in four groups. Groups I (n = 9) and III (n = 9) were transplanted with non perfused donor tissue. Animals in groups II (n = 9) and IV (n = 9) received grafts perfused with Collins solution. Immunosuppression with steroids and cyclosporin was continued for 21 days in groups III and IV. In a mid portion of the trachea viewed under optical microscope, the degree of inflammation or circumferential necrosis was assessed on a scale of 0 to 9 by adding the scores for mucosa, submucosa and cartilage. The mean score for tracheal lesion was lower in group IV, with a likelihood of random difference of less than 5%. Perfusion of peritracheal tissues with Collins solution in the donor, in addition to immunosuppression decreases the extent of tissue damage in the tracheal graft.

Topics: Analgesics, Opioid; Animals; Anti-Inflammatory Agents; Buprenorphine; Cefazolin; Cephalosporins; Cyclosporins; Data Interpretation, Statistical; Female; Hypertonic Solutions; Immunosuppression Therapy; Immunosuppressive Agents; Inflammation; Male; Methylprednisolone; Necrosis; Perfusion; Rabbits; Time Factors; Tissue Donors; Trachea