heroin and Gangrene

Long-term intravenous heroin abusers have problems of vascular access. After the accessible sites are sclerosed, the neck, axillae and groins are then used frequently. We report on 3 heroin abusers who presented with localized gangrene of the genitalia after injection into the femoral vessels. We postulate that the pathophysiology of this entity is related to arterial embolization of particulate matter into the microcirculation of the genitalia, which causes arterial thrombosis leading to localized gangrene. Of the 3 patients 2 were treated with local excision, débridement and primary closure. A fourth addict who injected heroin directly into the scrotum and perineum, presented with Fournier's gangrene, a completely different, more lethal entity.

Topics: Adult; Femoral Artery; Femoral Vein; Gangrene; Genital Diseases, Male; Heroin; Humans; Injections, Intra-Arterial; Injections, Intravenous; Male; Middle Aged; Penile Diseases; Scrotum; Substance-Related Disorders

Ingested cocaine can be a cause of severe bowel ischemia or gangrene. Two cocaine addicts who ingested large quantities of the drug developed severe abdominal symptoms and signs caused by bowel ischemia. In one patient gangrene of the bowel necessitated repeated resections and was followed, several weeks later, by death. The other patient suffered less severe ischemia and the bowel returned to normal. The diagnosis of bowel ischemia should be suspected whenever a cocaine addict has severe abdominal symptoms and signs. The presence of marked leukocytosis suggests bowel gangrene and demands prompt surgical intervention.

Topics: Adult; Cocaine; Colectomy; Colon; Female; Gangrene; Gastrointestinal Hemorrhage; Heroin; Humans; Ileostomy; Ileum; Intestinal Obstruction; Intestines; Ischemia; Necrosis; Substance-Related Disorders; Suicide, Attempted

Topics: Acanthosis Nigricans; Acne Vulgaris; Dental Caries; Dermatitis, Contact; Drug Eruptions; Edema; Gangrene; Hepatitis A; Heroin; Humans; Impetigo; Life Style; Pigmentation Disorders; Pruritus; Psychophysiologic Disorders; Purpura; Skin Diseases; Skin Manifestations; Substance-Related Disorders; Thrombophlebitis; Urticaria

Topics: Adult; Age Factors; Amenorrhea; Endocarditis; Female; France; Gangrene; Hepatitis; Heroin; Humans; Injections; Male; Middle Aged; Morphinans; Pharmaceutic Aids; Sepsis; Sexually Transmitted Diseases; Skin Manifestations; Social Behavior Disorders; Social Conditions; Substance-Related Disorders

Topics: Adult; Gangrene; Heroin; Humans; Injections, Intravenous; Lymphedema; Male; Substance-Related Disorders