heroin and Ischemia

In a random, double-blind crossover trial using an ischaemic limb pain model we have assessed the speed of onset of analgesia after an i.v. bolus of equipotent doses of diamorphine and morphine in 12 healthy male volunteers. Pain and its subsequent relief were assessed by means of a visual analogue scale. Two of the subjects found diamorphine acted quicker than morphine, one found no difference and nine found that morphine was quicker than diamorphine. The mean time to diamorphine effect was 53% greater than for morphine (P less than 0.005, Wilcoxon rank sum test). These findings suggest that, for rapid relief of pain, morphine is more suitable than diamorphine.

Topics: Adult; Arm; Double-Blind Method; Heroin; Humans; Injections, Intravenous; Ischemia; Male; Models, Biological; Morphine; Pain; Pain Measurement; Time Factors

Acute leg ischemia after intra-arterial drug injection represents a critical vascular emergency scenario. Due to lack of evidence-based standards therapeutic strategies are oriented to the underlying pathomechanisms. For a sufficient therapy a close clinical monitoring and laboratory analyses as well as treatment with analgesics, anticoagulants, anti-inflammatory and spasmolytic agents are of utmost importance. This article reports on the diagnostic and therapeutic approaches in a 32-year-old patient with acute leg ischemia after intra-arterial administration of heroin and secondary infection with Peptostreptococcus and Peptoniphilus species.

Topics: Acute Pain; Adult; Gram-Positive Bacterial Infections; Heroin; Humans; Injections, Intra-Arterial; Ischemia; Leg; Peptostreptococcus

We report on two patients with severe rhabdomyolysis and peripheral nerve involvement after drug intoxication. Nerve conduction studies of the paretic extremities of both patients could be performed within 12 h of the onset. Several nerves revealed evidence of conduction blocks in the paretic extremities. One of the patients who had taken heroin died and postmortem examination was performed. A drug-induced immune vasculitis could not be demonstrated. Besides striated muscle necrosis, extensive myocardial fragmentation was shown. Territorial ischemia, resulting from systemic hypotension and mechanical compression of arteries, seems to have been the cause of the myonecroses and peripheral nerve damage in the unconscious patients.

Topics: Adolescent; Adult; Cannabinoids; Ethanol; Fatal Outcome; Female; Flunitrazepam; Heart Arrest; Heroin; Humans; Illicit Drugs; Ischemia; Leg; Male; Muscle, Skeletal; Neurologic Examination; Peripheral Nerves; Psychotropic Drugs; Rhabdomyolysis; Substance-Related Disorders; Synaptic Transmission

A 35-year-old drug abuser inadvertently injected adulterated heroin into her left femoral artery and presented with critical ischaemia of her left leg. Treatment with intravenous Iloprost, a stable prostacyclin analogue, combined with Heparin, produced a dramatic improvement in her circulation within 4 h.

Topics: Adult; Blood Pressure; Drug Therapy, Combination; Female; Femoral Artery; Heparin; Heroin; Humans; Iloprost; Infusions, Intravenous; Ischemia; Leg; Substance Abuse, Intravenous

Accidental, intraarterial injections of abused substances continue to be difficult management problems because of severe vascular complications. Vasospasm probably plays an important role in the pathophysiology of this injury, in addition to the more accepted roles of thrombosis and endarteritis. Three patients with severe, upper extremity ischemia after intraarterial injection of heroin, methamphetamine, and meperidine were treated with intraarterial tolazoline and streptokinase, along with intravenous heparin. All three patients had improved perfusion, assessed both clinically and by angiography. The responses to treatment in these patients demonstrated the roles of vasospasm and thrombosis in the origin of this injury and the therapeutic benefits of appropriately administered vasodilators and thrombolytic agents.

Topics: Adult; Angiography; Arm; Brachial Artery; Female; Hand; Heroin; Humans; Injections, Intra-Arterial; Ischemia; Male; Meperidine; Methamphetamine; Substance Abuse, Intravenous; Tolazoline; Vasodilator Agents

The paper describes five cases of accidental intraarterial injection of pharmacological drugs (diazepam or thiopentone) or dope (heroin) in an upper limb. Following a review of the physiopathological mechanisms which led to ischemic damage, the Authors outline a protocol of continuous pharmacological sympathicolysis in the affected limb, using repeated anesthetic blocks of the homolateral stellate ganglion.

Topics: Arm; Autonomic Nerve Block; Diazepam; Heroin; Humans; Injections, Intra-Arterial; Ischemia; Regional Blood Flow; Stellate Ganglion; Syndrome; Thiopental

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

A patient presented with a painful, oedematous, cyanosed hand having injected a solution of diamorphine and methylphenidate into his radial artery. Treatment was started with heparin and vasodilators. Benefit from this was limited and a course of intra-arterial urokinase was instituted. This gave almost total resolution of the injury. The mechanisms producing ischaemia following intra-arterial injection of drugs of abuse and possible treatment are discussed.

Topics: Accidents; Adult; Forearm; Heroin; Humans; Injections, Intra-Arterial; Ischemia; Male; Methylphenidate; Substance-Related Disorders; Urokinase-Type Plasminogen Activator

Three cases of hypoxic-ischemic leukoencephalopathy were studied. In two patients, the neurologic disorder followed drug overdosage; in the third, the apparent precipitating event was a postoperative myocardial infarction complicated by circulatory insufficiency. All patients were deeply unresponsive, with varying reflex patterns. In all three cases, the brain showed extensive symmetrical necrotic lesions of the central white matter, with minimal damage to gray matter structures. The lesions in case 3 showed, in addition, vascular necrosis and ring hemorrhages. Common to all cases was a prolonged period of hypoxemia, hypotension, and elevated venous pressure. Acidosis occurred in two. These observations and analysis of previous reports of similar cases suggest that leukoencephalopathy tends to occur when the hypoxemia is prolonged and is associated with periods of hypotension and metabolic imbalance.

Topics: Adult; Aged; Brain; Brain Damage, Chronic; Female; Glutethimide; Heroin; Humans; Hypotension; Hypoxia, Brain; Ischemia; Male; Myocardial Infarction

Topics: Aneurysm, Infected; Arterial Occlusive Diseases; Cardiomegaly; Edema; Endocarditis, Bacterial; Hand; Heroin; Humans; Injections, Intra-Arterial; Injections, Intravenous; Ischemia; Lung Diseases; Lymphadenitis; Pneumonia; Pneumonia, Aspiration; Pulmonary Edema; Pulmonary Embolism; Substance-Related Disorders; Tuberculosis, Pulmonary; Vascular Diseases; Venous Insufficiency

Topics: Adult; Barbiturates; Female; Foreign Bodies; Heroin; Heroin Dependence; Humans; Injections; Injections, Intra-Articular; Injections, Intramuscular; Injections, Intravenous; Injections, Subcutaneous; Ischemia; Male; Muscles; Opium; Phlebography; Substance-Related Disorders; Surgical Procedures, Operative; Thrombophlebitis

Topics: Acute Kidney Injury; Adult; Coma; Contracture; Female; Heroin; Humans; Ischemia; Male; Muscles; Muscular Diseases; Pressure; Pressure Ulcer; Secobarbital; Skin Diseases; Substance-Related Disorders

Topics: Adolescent; Adult; Aged; Burns; Colon; Endotoxins; Female; Gastrointestinal Hemorrhage; Heroin; Humans; Intestinal Obstruction; Ischemia; Kidney Transplantation; Liver Cirrhosis; Liver Diseases; Lung Diseases, Parasitic; Male; Middle Aged; Mononuclear Phagocyte System; Morphine Dependence; Peritonitis; Sepsis; Shock, Septic; Transplantation, Homologous; Urinary Fistula; Urinary Tract Infections

Topics: Adult; Amphetamine; Amputation, Surgical; Aneurysm; Angiography; Arm; Arteries; Barbiturates; Blood Vessels; Candidiasis; Codeine; Endocarditis, Bacterial; Female; Heparin; Heroin; Humans; Injections, Intra-Arterial; Ischemia; Leg; Male; Methylphenidate; Substance-Related Disorders; Vascular Diseases; Vasodilator Agents; Veins