heroin and Pulmonary-Edema

Medical complications of heroin overdose and the diseases of addicts play an increasingly important role in the daily routine of hospital medical departments. The percentage of drug-related admissions to the Medical Clinic of the University Hospital, Zürich, increased from 0.18% to 4.45% between 1972 and 1983. During this 12-year period, 492 patients were admitted 569 times because of heroin overdose or intoxications combined with other drugs, and 191 drug addicts were hospitalized 226 times for a variety of medical problems. Certain complications, such as heroin pulmonary edema and talc granulomas of the lung, occur only in parenteral drug addiction. Other diseases such as right heart endocarditis, Candida-endophthalmitis, septic arthritis and osteomyelitis are almost exclusively observed in intravenous drug abusers. Sexually transmitted infections and hepatitis B are frequently diagnosed in addicts.

Topics: Adolescent; Adult; Age Factors; Arthritis, Infectious; Candidiasis; Cardiovascular Diseases; Endocarditis, Bacterial; Female; Hepatitis, Viral, Human; Heroin; Heroin Dependence; Humans; Length of Stay; Lung Diseases; Male; Nervous System Diseases; Osteomyelitis; Pulmonary Edema; Rhabdomyolysis; Sex Factors; Sexually Transmitted Diseases; Skin Diseases; Switzerland

Several mechanisms leading to noncardiac pulmonary edema have been reviewed. Common features are damage to and increased permeability of vascular endothelium, interstitial and alveolar edema fluid high in protein content, increased pulmonary vascular resistance and pressure, nondependent distribution of the edema and normal left atrial or wedge pressure. The available evidence suggests that in some instances the sites of leakage are the pulmonary arterial walls and, perhaps in some, overperfused, damaged capillary beds. Therapeutic obestives differ from those in cardiac pulmonary edema in that efforts are directed toward a reduction in pulmonary blood flow and pulmonary arterial pressure during the period that endothelial healing is taking place.

Topics: Altitude Sickness; Animals; Bacterial Infections; Brain Injuries; Capillaries; Capillary Permeability; Ethchlorvynol; Heroin; Humans; Hypersensitivity; Hypoxia; Lung; Paraquat; Pulmonary Alveoli; Pulmonary Artery; Pulmonary Edema; Respiratory Distress Syndrome; Ultrafiltration

Topics: Altitude Sickness; Central Nervous System Diseases; Dextropropoxyphene; Drowning; Ethchlorvynol; Hemodynamics; Heroin; Humans; Lung; Oxygen; Pancreatitis; Pulmonary Edema; Respiratory Distress Syndrome; Respiratory Therapy; Salicylates; Smoke; Syndrome

Topics: Anti-Bacterial Agents; Anticoagulants; Antihypertensive Agents; Bleomycin; Busulfan; Chlorpropamide; Cyclophosphamide; Hemorrhage; Heroin; Humans; Hydrochlorothiazide; Hypertension, Pulmonary; Inhalation; Leukemia, Lymphoid; Lipids; Lung; Lung Diseases; Methotrexate; Methysergide; Nitrofurantoin; Phenytoin; Pulmonary Edema

Topics: Altitude; Animals; Capillary Resistance; Cell Membrane Permeability; Dogs; Extracellular Space; Heroin; Humans; Infant; Lung; Lymphatic System; Mechanoreceptors; Microcirculation; Microscopy, Electron; Pulmonary Alveoli; Pulmonary Edema; Pulmonary Surfactants; Shock; Substance-Related Disorders; Water-Electrolyte Balance

Topics: Acute Disease; Brain Diseases; Brain Injuries; Chronic Disease; Gas Poisoning; Heart Diseases; Heroin; Humans; Hypersensitivity; Iatrogenic Disease; Infusions, Parenteral; Kidney Failure, Chronic; Mountaineering; Pulmonary Edema; Radiography; Renal Dialysis; Sympathomimetics

Naloxone is standard medication for the treatment of heroin intoxications. No large-scale studies have yet been carried out to determine its toxicity in heroin intoxications.. We have undertaken an investigation as to the frequency, type and degree of severity of complications attributable to naloxone administration. Subjects treated between 1991 and 1993 with naloxone for intravenous drug intoxications were prospectively evaluated.. Development of ventricular tachycardia or fibrillation; atrial fibrillation; asystole; pulmonary edema; convulsions; vomiting; and violent behavior within ten minutes after parenteral administration of naloxone.. Six of 453 intoxicated subjects (1.3%; 95% confidence interval 0.4%-3%) suffered severe adverse effects within ten minutes after naloxone administration (one asystole; three generalized convulsions; one pulmonary edema; and one violent behavior). After the ten minute period, no further complications were observed.. The short time between naloxone administration and the occurrence of complications, as well as the type of complications, are strong evidence of a causal link. In 1000 clinically diagnosed intoxications with heroin or heroin mixtures, from 4 to 30 serious complications can be expected. Such a high incidence of complications is unacceptable and could theoretically be reduced by artificial respiration with a bag valve device (hyperventilation) as well as by administering naloxone in minimal divided doses, injected slowly.

Topics: Adolescent; Adult; Aggression; Cocaine; Confidence Intervals; Drug Overdose; Female; Heart Arrest; Heroin; Humans; Illicit Drugs; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Naloxone; Narcotic Antagonists; Prospective Studies; Pulmonary Edema; Seizures; Substance Abuse, Intravenous

Topics: Adult; Analgesics, Opioid; Drug Overdose; Fentanyl; Heroin; Heroin Dependence; Humans; Hypoxia; Lung; Male; Naloxone; Narcotic Antagonists; Pulmonary Edema; Radiography, Thoracic; Substance Abuse, Intravenous

To investigate frequent findings in cases of fatal opioid intoxication in whole-body post-mortem computed tomography (PMCT).. PMCT of 55 cases in which heroin and/or methadone had been found responsible for death were retrospectively evaluated (study group), and were compared with PMCT images of an age- and sex-matched control group. Imaging results were compared with conventional autopsy.. The most common findings in the study group were: pulmonary oedema (95 %), aspiration (66 %), distended urinary bladder (42 %), cerebral oedema (49 %), pulmonary emphysema (38 %) and fatty liver disease (36 %). These PMCT findings occurred significantly more often in the study group than in the control group (p < 0.05). The combination of lung oedema, brain oedema and distended urinary bladder was seen in 26 % of the cases in the study group but never in the control group (0 %). This triad, as indicator of opioid-related deaths, had a specificity of 100 %, as confirmed by autopsy and toxicological analysis.. Frequent findings in cases of fatal opioid intoxication were demonstrated. The triad of brain oedema, lung oedema and a distended urinary bladder on PMCT was highly specific for drug-associated cases of death.. Frequent findings in cases of fatal opioid intoxication were investigated. Lung oedema, brain oedema and full urinary bladder represent a highly specific constellation. This combination of findings in post-mortem CT should raise suspicion of intoxication.

Topics: Adolescent; Adult; Autopsy; Brain Edema; Cardiomegaly; Cause of Death; Female; Forensic Pathology; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Narcotics; Pulmonary Edema; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Urinary Bladder; Whole Body Imaging; Young Adult

During the summer of 2005, multiple cities in the United States began to report outbreaks of fentanyl-associated fatalities among illicit drug users. The objectives of this study were to (1) determine if an outbreak of fentanyl-associated fatalities occurred in mid-2005 to mid-2006 and (2) to examine trends and compare features of fentanyl-contaminated heroin-associated fatalities (FHFs) with non-fentanyl, heroin-associated fatalities (NFHFs) among illicit drug users.. Baseline prevalence of fentanyl- and heroin-associated deaths was estimated from January to May 2005 based on recorded cause of death (determined by the medical examiner (ME)) using the Wayne County, MI, USA toxicology database. The database was then queried for both FHFs and NFHFs between July 1, 2005 and May 12, 2006. A FHF was defined as having fentanyl or norfentanyl (metabolite) detected in any postmortem biological sample and either (1) detection of heroin or its metabolite (6-acetylmorphine) and/or cocaine or its metabolite (benzoylecgonine) in a postmortem biological specimen or (2) confirmation of fentanyl abuse as the cause of death by the ME or a medical history available sufficient enough to exclude prescription fentanyl or other therapeutic opioid use. A NFHF was defined as detection of heroin, 6-acetylmorphine (heroin metabolite) or morphine in any postmortem biological specimen, heroin overdose listed as the cause of death by the ME, and absence of fentanyl detection on postmortem laboratory testing. Information was systematically collected, trended for each group and then compared between the two groups with regard to demographic, exposure, autopsy, and toxicology data. Logistic regression was performed using SAS v 9.1 examining the effects of age, gender, and marital status with fentanyl group status.. Monthly prevalence of fentanyl-associated fatalities among illicit drug users increased from an average of two in early 2005 to a peak of 24 in May, 2006. In total, 101 FHFs and 90 NFHFs were analyzed. The median age of decedents was 46 and 45 years for the fentanyl and non-fentanyl groups, respectively. Fentanyl-contaminated heroin-associated fatalities (FHFs) were more likely to be female (p = 0.003). Women aged over 44 years (OR = 4.67;95 % CI = 1.29-16.96) and divorced/widowed women (OR = 14.18;95 % CI = 1.59-127.01) were more likely to be FHFs when compared to women aged less than 44 years and single, respectively. A significant interaction occurred between gender and age, and gender and marital status. Most FHFs had central (heart) blood samples available for fentanyl testing (n = 96; 95 %): fentanyl was detected in most (n = 91; 95 %). Of these, close to half had no detectable heroin (or 6-acetylmorphine) concentrations (n = 37; 40.7 %). About half of these samples had detectable cocaine concentrations (n = 20; 54 %). Median fentanyl concentration in central blood samples was 0.02 μg/ml (n = 91, range <0.002-0.051 μg/ml) and 0.02 μg/ml (n = 32, range <0.004-0.069 μg/ml) in peripheral blood samples. The geometric mean of the ratio of central to peripheral values was 2.10 (median C/P = 1.75). At autopsy, pulmonary edema was the most frequently encountered finding for both groups (77 %).. Illicit drugs may contain undeclared ingredients that may increase the likelihood of fatality in users. Gender differences in fentanyl-related mortality may be modified by age and/or marital status. These findings may help inform public health and prevention activities if fatalities associated with fentanyl-contaminated illicit drugs reoccur.

Topics: Adolescent; Adult; Cause of Death; Drug Contamination; Drug Overdose; Female; Fentanyl; Heroin; Humans; Illicit Drugs; Male; Michigan; Middle Aged; Narcotics; Opioid-Related Disorders; Prevalence; Pulmonary Edema; Sex Factors; Substance-Related Disorders; Survival Rate; Young Adult

A "foam cone" exuding the mouth and nostrils is a recognized consequence of anoxia following pulmonary edema. In this report, we illustrate and explain this phenomenon in victims of heroin overdose.

Topics: Drug Overdose; Heroin; Humans; Pulmonary Edema

To compare pathological and toxicological features between opiate overdose and non-opiate overdose fatalities examined in the Department of Forensic Medicine, Chiang Mai University, Thailand.. A retrospective study of 142 cases, diagnosed as opiate-related deaths between 1996 and 2008 was conducted. Demographic data, pathological findings and toxicological results were retrieved from autopsy records.. Within these 142 opiate-related deaths, 102 cases were classified as opiate overdose fatalities by Forensic Medicine doctors. More than 95% ofcases were male. About 80% were aged 20 to 39 years. Forty-eight percent were Thai, 13% were British and 11% were American. The most commonplaces of death were residential areas and hotels. Pulmonary edema and needle marks were more common in opiate overdose cases than in non-opiate overdose cases. Toxicological findings showed that 61% of opiate overdose cases and 34% of non-opiate overdose cases were positive for blood morphine. Morphine was detected in about 95% of urine samples in both groups. About 62% of opiate overdose cases and 31% of non-opiate overdose cases had positive blood alcohol.. The average incidence of opiate-related death was about 1% of autopsy cases. More than two thirds of the deaths were opiate overdose cases. After the year 2003, more foreigners suffered from opiate overdose fatalities than Thais. The fatalities were confined to an area frequented by tourists. Pulmonary edema and needle puncture marks were more frequently observed in opiate overdose cases. The number of cases of morphine detection in serum from the opiate overdose group was significantly higher than in the non-opiate overdose group. There was no significant difference in urine morphine detection between both groups. Other substances detected in these victims were alcohol, benzodiazepines, methamphetamine, methylenedioxymethamphetamine and methadone. Alcohol was found significantly higher in opiate overdose fatality than in non-opiate overdose deaths.

Topics: Adult; Aged; Aged, 80 and over; Drug Overdose; Female; Heroin; Humans; Male; Middle Aged; Morphine; Opioid-Related Disorders; Pulmonary Edema; Retrospective Studies; Young Adult

Topics: Adult; Drug Overdose; Female; Heroin; Humans; Intubation, Intratracheal; Naloxone; Narcotic Antagonists; Pulmonary Edema; Toxicology

Topics: Drug Overdose; Emergency Service, Hospital; Heroin; Heroin Dependence; Humans; Narcotics; Pulmonary Edema

A 20-year old woman presented with prolonged refractory ventricular fibrillation and pulmonary oedema following hypothermia while she was under self-administered heroin in an attempt to commit suicide. She was successfully resuscitated with cardiopulmonary bypass for core rewarming and internal defibrillation.

Topics: Adult; Cardiopulmonary Bypass; Drug Overdose; Female; Heroin; Humans; Hypothermia; Pulmonary Edema; Suicide, Attempted; Ventricular Fibrillation

We report a case of death due to the effects of heroin concealed in a woman who was attempting to smuggle the drug into Kenya concealed within her gastro-intestinal tract. She was arrested at a Nairobi airport. While under police detention, she expelled a pellet par anum containing the drug then collapsed, after being forcefully fed on a heavy meal. She was taken to hospital in coma where she expelled nine pellets and died three days later. Her blood level of heroin at admission was well beyond the lethal dose. Details are provided of the circumstances leading to her admission into hospital, her stay in hospital and the autopsy findings. At autopsy 88 pellets were retrieved from her body. The main pathological findings included pulmonary and cerebral edema. Despite the presence of free heroin in the gastric contents, toxicological analysis did not demonstrate any heroin or its metabolites in blood or tissue extracts. This case illustrates the challenges in postmortem evaluation of narcotic fatalities and the need to consider all factors such as antemortem history, toxicology results and autopsy findings in forensic diagnosis

Topics: Adult; Autopsy; Brain Edema; Coma; Drug Implants; Fatal Outcome; Female; Gastrointestinal Tract; Heroin; Humans; Kenya; Pulmonary Edema; Syndrome

The study objective was to describe the morbidity of patients presenting with heroin overdose (HOD)-induced noncardiogenic pulmonary edema (NCPE) at an urban ED. A retrospective chart review of patients presenting between 1996 and 1999 with the diagnosis of HOD was conducted. Using a standardized data abstraction form, information on prehospital care, ED care, demographics, and cointoxications was collected. One hundred twenty-five charts (78%) were available for review. Of these, 13 (10%) were diagnosed with NCPE and all were male. In the field, NCPE patients had an average relative risk of 6, a Glasgow Coma Scale of 4, and all needed naloxone. The average admitted duration of use was 2.9 years for those who developed NCPE compared with 13.2 years for those who did not. Five (42%) NCPE patients tested positive for cocaine use and 7 (58%) tested positive for alcohol. In this cohort, the NCPE patients were male and less experienced users with initial low relative risk and Glasgow Coma Scale which demanded prehospital naloxone use. (Am J Emerg Med 2003;21:32-34.

Topics: Adult; Cohort Studies; Drug Overdose; Emergency Service, Hospital; Female; Heroin; Heroin Dependence; Hospitals, Urban; Humans; Male; Middle Aged; Narcotics; Pulmonary Edema; Retrospective Studies; Risk Factors; Time Factors

Topics: Adult; Capillary Leak Syndrome; Critical Care; Drug Overdose; Heroin; Humans; Male; Oxygen Inhalation Therapy; Pulmonary Edema; Respiratory Insufficiency

To examine the current clinical spectrum of noncardiogenic pulmonary edema (NCPE) related to heroin overdose.. Retrospective chart review of all identified patients from August 1994 through December 1998.. Urban academic hospital.. Heroin-related NCPE was defined as the syndrome in which a patient develops significant hypoxia (room air saturation < 90% with a respiratory rate > 12/min) within 24 h of a clinically apparent heroin overdose. This should be accompanied by radiographic evidence of diffuse pulmonary infiltrates not attributable to other causes, such as cardiac dysfunction, pneumonia, pulmonary embolism, or bronchospasm, and which resolve clinically and radiographically within 48 h.. None.. Twenty-seven patients were identified during this 53-month period, with a majority being male patients (85%; average age, 34 years). Twenty patients (74%) were hypoxic on emergency department arrival, and 6 patients (22%) had symptoms develop within the first hour. One patient had significant hypoxia develop within 4 h. Nine patients (33%) required mechanical ventilation, and all intubated patients but one were extubated within 24 h. Eighteen patients (66%) were treated with supplemental oxygen alone. Hypoxia resolved spontaneously within 24 h in 74% of patients, with the rest (22%) resolving within 48 h. Twenty patients (74%) had classical radiograph findings of bilateral fluffy infiltrates, but unilateral pulmonary edema occurred in four patients (15%) and more localized disease occurred in two patients (7%).. NCPE is an infrequent complication of a heroin overdose. The clinical symptoms of NCPE are clinically apparent either immediately or within 4 h of the overdose. Mechanical ventilation is necessary in only 39% of patients. The incidence of NCPE related to heroin overdose has decreased substantially in the last few decades.

Topics: Adult; Drug Overdose; Female; Heroin; Heroin Dependence; Humans; Male; Pulmonary Edema; Retrospective Studies

Pulmonary edema complicating heroin overdosage is a well recognized entity and regarded as the major mechanism contributing to death in heroin addicts. It's pathogenesis is unknown, several mechanisms are discussed: hypoxia-induced increase of pulmonary capillary permeability, depressed myocardial contractility, centrally induced respiratory depression, primary toxic effects on the alveolar capillaries and acute anaphylactic shock. The present study included opiate-related deaths (n=23) and a control group of sudden cardiovascular deaths (n=12) to verify the hypothesis, that defects of the alveolar capillary membranes and/or an acute anaphylactic reaction leads to pulmonary congestion, edema and hemorrhages. Lung specimens were obtained from these 35 autopsies of persons autopsied in the Institute of Forensic Medicine, University of Bonn, in 1997 and 1998. All specimens were examined with hematoxylin-eosin, prussian blue and investigated with immunohistological methods using primary antibodies against collagen IV, laminin and IgE. Defects of the basal laminae of the alveoli were found, demonstrated by laminin and collagen IV, and the number of IgE-positive cells was counted in both groups. There was an increased but not significant number of IgE-positive cells in the heroin-group and defects of the epithelial and endothelial basal laminae were found in both groups without significant differences.

Topics: Anaphylaxis; Antibodies; Basement Membrane; Capillaries; Capillary Permeability; Cause of Death; Collagen; Coloring Agents; Death, Sudden, Cardiac; Drug Overdose; Endothelium, Vascular; Epithelial Cells; Female; Hemorrhage; Heroin; Heroin Dependence; Humans; Hypoxia; Immunoglobulin E; Immunohistochemistry; Laminin; Male; Myocardial Contraction; Narcotics; Pulmonary Alveoli; Pulmonary Edema; Respiration

Diphenhydramine (DPH)-related deaths in adults are extremely rare, and detailed autopsy studies are rarer still. Toxicologic and anatomic findings in 4 cases of suicidal DPH overdose are described and compared with findings in a database of cocaine- and heroin-related deaths. Blood DPH levels were many times higher than those considered therapeutic (5000-35,000 ng/ml versus 50-100 ng/ml). Marked pulmonary edema with visceral congestion was a constant finding. Mean lung-body weight ratios for DPH, cocaine, heroin, and trauma controls were 0.015, 0.015, 0.019, and 0.013, respectively. When normalized for body weight in this fashion, edema in DPH-related deaths was comparable to that in cocaine-related deaths. Cardiac enlargement was apparent in 3 of the 4 DPH cases, 1 with marked myocardial fibrosis. The finding of increased heart size suggests that preexisting heart disease may provide the necessary substrate for lethal cases of DPH toxicity. Pulmonary edema in these cases remains unexplained, with edema in cases of heroin-related toxicity significantly worse than that produced by cocaine or DPH (p < .0001). Because DPH and cocaine can exert similar effects on the heart, a common mechanism may produce pulmonary edema in both. A different mechanism may account for heroin-related edema.

Topics: Adolescent; Adult; Cardiomyopathy, Dilated; Cocaine; Diphenhydramine; Drug Overdose; Fatal Outcome; Female; Fibrosis; Heroin; Humans; Male; Middle Aged; Myocardium; Organ Size; Pulmonary Edema; Suicide

The combination of severe hypothermia and noncardiogenic pulmonary edema secondary to an opiate overdose is presented. This case emphasizes the importance of ventilatory support and rewarming techniques available in the emergency department setting.

Topics: Drug Overdose; Heroin; Humans; Hypothermia; Male; Pulmonary Edema; Substance-Related Disorders

After intravenous injection of heroin, a 27-year-old male with altered mental status and hypotension was seen at the Emergency Service where acute pulmonary edema was noted. The problem was resolved three days later after oxygen therapy had been administered by face mask. Acute renal failure, rhabdomyolysis and monoplegia of the patient's left leg were exhibited during his stay at the Intensive Care Unit. Neurological examination and electro-diagnostic studies (electromyography and nerve conduction velocity) showed left lumbosacral plexitis. Hemodialysis was given. Though the patient's hospital course was uneventful, satisfactory recovery from his left leg weakness, which persisted for one year after hospital discharge, was finally achieved.

Topics: Acute Disease; Acute Kidney Injury; Adult; Heroin; Humans; Lumbosacral Plexus; Male; Neuritis; Pulmonary Edema; Rhabdomyolysis

Topics: Combined Modality Therapy; Heroin; Humans; Poisoning; Pulmonary Edema; Respiratory Distress Syndrome

Comprehensive investigation is necessary for determining the cause of death in cases with positive drug screens. We investigated the case of a male who reportedly expired from an acute asthma attack. He had limited access to both therapeutic drugs and drugs of abuse because he was a state prisoner. His autopsy was remarkable because the weights of his right and left lungs were 690 and 760 g, respectively. His upper airway was clear of debris. There was an abundant amount of blood and frothy fluid in the pulmonary parenchyma. There were no focal lesions. The pulmonary vasculature was unremarkable. Microscopic evaluation of the lung tissue showed that the bronchi contained dense inflammatory infiltrates consisting mostly of eosinophils and a few lymphocytes and plasma cells. Basement membrane thickening was evident in the bronchi, and mucous plugs were identified in some of the bronchial lumina. A morphine concentration of 80 ng/mL was found in the blood. Theophylline and albuterol were detected in trace amounts. The opinion of the coroner was that the patient died of an acute asthma attack, and the presence of morphine may have contributed to his death. A careful review of his medical history and the mechanisms of drug-induced asthma revealed that the etiology of his death was more likely due to heroin abuse and noncardiogenic pulmonary edema. Episodic exacerbations of his chronic asthma were a contributing factor in his demise. However, in and of itself, asthma was not responsible for his death. Pertinent information associated with this case is presented, along with additional findings of toxicological screens and other evidence demonstrating that his asthma treatment did not contribute to his death. In addition, opiate-induced asthma, as well as other drug-induced diseases that can contribute to mortality in patients who abuse narcotics, is reviewed.

Topics: Administration, Inhalation; Adult; Albuterol; Asthma; Fatal Outcome; Heroin; Humans; Lung; Male; Morphine; Pulmonary Edema; Rhinitis, Allergic, Perennial; Substance-Related Disorders; Theophylline

Heroin lung is the most frequent complication of heroin intoxication. In September 1991 and January 1993, two young men aged 19 and 22 years presented with a sudden loss of consciousness and cyanosis after injecting heroin. They were both brought to our emergency department in the night and were immediately intubated and given 100% oxygen. Following intravenous naloxone, they both regained consciousness. The first patient's chest X ray revealed increased bilateral perihilar lung markings and mild patchy alveolar edema while the second patient showed a bat's wing shaped confluent alveolar edema. The blood gases in both cases revealed hypoxemia and hypercapnia. Follow-up chest roentgenograms on the second hospital day in case 1 and the third hospital day in case 2 revealed partial clearing of the lung fields. Fever developed on the second hospital day and they both received two weeks of antibiotics prior to discharge. Case 1 had normal pulmonary function testing, but case 2 developed mild restrictive lung changes. Review of the literature shows that heroin can cause a fulminant but rapidly reversible form of pulmonary edema. The treatment for this noncardiogenic pulmonary edema is adequate ventilation, good pulmonary toilet, and naloxone to reverse the respiratory and central nervous system depression. Diuretics, digitalis and morphine are not recommended in the treatment of heroin lung.

Topics: Adult; Heroin; Humans; Male; Pulmonary Edema

Topics: Adult; Diagnosis, Differential; Drug Overdose; Heroin; Humans; Male; Pneumonia, Aspiration; Pulmonary Edema; Radiography

Pulmonary oedema lasting six days occurred in a 68 year old man after sniffing cocaine. He also had evidence of parenteral self-administration of heroin. Pulmonary microvascular filtration pressure and permeability were normal. Delayed resolution of the pulmonary oedema may have been caused by a cocaine-induced impairment of sodium and thus fluid transport across alveolar epithelium. Recognition may be important, since lowering filtration pressure with diuretics may not hasten resolution of oedema.

Topics: Aged; Cocaine; Heroin; Humans; Lung; Male; Pulmonary Edema; Radiography; Substance-Related Disorders; Time Factors

Topics: Drug Overdose; Heroin; Humans; Naloxone; Patient Discharge; Pulmonary Edema; Substance Abuse, Intravenous

Based on a case story and having examined the literature, we describe the incidence, symptoms, course, complications and treatment of the kind of pulmonary oedema that may arise in connection with acute heroin intoxication. A possible pathogenesis is also discussed. Heroin-induced pulmonary oedema is rather frequent and the mortality is high. It differs from cardiogenic pulmonary oedema at essential points. It is most likely due to an increased permeability of the lung capillaries. However, it is still unclarified whether this is caused by a toxic or an allergic reaction, or by hypoxia. The treatment is supportive, using a respirator and oxygen enriched breathing air until the hypoxia has been abolished, and support of the circulation with reasonable liquid supply and infusion of inotropic and vasoactive drugs.

Topics: Adult; Heroin; Heroin Dependence; Humans; Male; Pulmonary Edema

Topics: Acute Disease; Adult; Drug Overdose; Heroin; Humans; Male; Naloxone; Pulmonary Edema; Substance-Related Disorders

A case is described of a young man who presented with acute pulmonary edema and flaccid paralysis of the right upper and lower extremity, following his first injection of heroin and was found in a comatose state. Needle electromyographic findings were compatible with a severe lesion of the right brachial plexus and a moderate lesion of the right lumbar plexus. An allergic or a hypersensitivity reaction might have been the possible cause.

Topics: Acute Disease; Adult; Brachial Plexus; Drug Hypersensitivity; Heroin; Humans; Inflammation; Lumbosacral Plexus; Male; Paralysis; Pulmonary Edema

Topics: Adult; Dose-Response Relationship, Drug; Female; Heroin; Heroin Dependence; Humans; Male; Pulmonary Edema

The authors report two cases of heroin induced pulmonary edema. In both cases the severity of respiratory failure, attested by a deep hypoxemia (paO2 28 and 32 mmHg) and a metabolic and respiratory acidosis (pH 7.07 and 7.14) imposed an artificial ventilation with positive end expiratory pressure (PEEP). Hemodynamic study revealed a noncardiogenic edema. In both cases, a cardiac insufficiency was also present : in the first case it's etiology remained unclear, in the second it was a complication of hyperkalemia.

Topics: Acidosis; Adult; Hemodynamics; Heroin; Humans; Male; Positive-Pressure Respiration; Pulmonary Edema; Time Factors

A case of acute left ventricular failure following an intravenous dose of amphetamine is described. The diagnosis was made by right heart catheterization. This is the first description of acute amphetamine cardiomyopathy in the medical literature.

Topics: Acute Disease; Adult; Amphetamine; Cardiomyopathies; Catheterization; Heroin; Humans; Male; Pulmonary Edema; Substance-Related Disorders

The incidence of acute, fatal narcotism in San Francisco was determined to be 3.2% of all deaths (10 882) subject to medical examiner's inquiry in a five-year period. Heroin was responsible for the greatest number of these cases, usually accompanied by alcohol or other abused drugs. The median concentration of the heroin metabolite, morphine, in the blood in fatal cases was 20 microgram/dL. Death from propoxyphene, the second most frequently encountered narcotic, was generally determined to be suicidal, while death from heroin was judged to be accidental. The highest rate occurred in black males between the ages of 21 and 30 years. The three most consistent findings were positive identification of the drug in the body (100% of the cases), pulmonary edema (90.4% of the cases), and microscopic liver changes (71.1% of the cases).

Topics: Adolescent; Adult; Aged; California; Dextropropoxyphene; Female; Heroin; Humans; Liver; Male; Middle Aged; Morphine Derivatives; Mortality; Narcotics; Pulmonary Edema; Sex Factors

Topics: Adult; Heroin; Humans; Injections, Intravenous; Male; Pulmonary Edema

Topics: Acute Disease; Adult; Heroin; Humans; Injections, Intravenous; Male; Pulmonary Edema

Drug-induced lung diseases may present themselves as bronchial reactions (e.g. bronchial asthma), diseases of the parenchyma (e.g. pulmonary infiltrates with eosinophilia, diffuse fibrosing alveolitis), of the pulmonary vasculature (vasculitis) and of the pleura (e.g. pleurisy or pleural fibrosis). Pathogenetically the two most pertinent types of reaction are hypersensitivity or toxic reactions, and less often biologic reactions such as opportunistic infections after cytotoxic and immunosuppressive therapy. Many drug-induced respiratory diseases are reversible upon withdrawal of the offending agent; others may be irreversible or even progress.

Topics: Aspirin; Asthma; Bronchitis; Busulfan; Contraceptives, Oral, Hormonal; Dose-Response Relationship, Drug; Drug Hypersensitivity; Drug Interactions; Drug Tolerance; Heroin; Humans; Iodides; Lung Diseases; Methysergide; Pituitary Hormones, Posterior; Pleural Diseases; Polyarteritis Nodosa; Pulmonary Edema; Pulmonary Embolism; Pulmonary Eosinophilia; Trypsin

Alveolar fluid and plasma proteins were analyzed in 24 patients with florid pulmonary edema, in 21 of whom pulmonary capillary wedge pressure (Pcw) was also measured. In all patients with Pcw less than 20 mm Hg, the edema fluid to plasma protein ratio exceeded 0.6; the mean edema fluid to plasma protein ratio in the four patients with cardiogenic edema (increased Pcw) was 0.46. In the 21 patients in whom full data were available, the net intravascular filtration force (Pcw - plasma colloid osmotic pressure) was less than -4 mm Hg, the value at which (according to others) pulmonary edema should occur, in only 10. When the interstitial colloid osmotic pressure, approximated by the osmotic pressure of edema fluid protein, was added, the net filtration force became positive in 17 of 21 patients. Comparison of the protein concentrations of edema fluid and plasma aids in the diagnostic separation of increased permeability from high hydrostatic pressure edema and adds to our understanding of the relative osmotic and hydrostatic forces that contribute to pulmonary edema when the alveolar-capillary membrane is damaged.

Topics: Adolescent; Adult; Aged; Blood Pressure; Blood Proteins; Body Fluids; Capillary Permeability; Female; Filtration; Heroin; Humans; Hydrostatic Pressure; Male; Middle Aged; Nervous System Diseases; Osmotic Pressure; Phenobarbital; Plasma; Pneumonia, Viral; Proteins; Pulmonary Alveoli; Pulmonary Edema; Shock, Hemorrhagic

Acute hemodynamic changes during heroin overdose have not been frequently reported. We observed 2 male patients aged 24 and 21 years admitted in coma and shock and presenting severe mixed acidosis, with, respectively, pH 6.80, PaCO2 72 mm Hg, PaO2 70 mm Hg, BE -18 mEq/l, lactic acid 16.5 mmol/l, and pH 6.86, PaCO2 94 mm Hg, PaO2 46 mm Hg, BE -16 mEq/l, lactic acid 5.45 mmol/l. The hemodynamic data of the first patient showed a low output failure state associated with high filling pressures, suggesting biventricular heart failure. In the second case, clinically and radiologically marked pulmonary edema was associated with a hyperdynamic state and moderately elevated pulmonary artery pressure, but normal pulmonary capillary pressure. The possible pathophysiological mechanisms of those different, hemodynamic patterns are discussed.

Topics: Acidosis; Adult; Bicarbonates; Blood Pressure; Heart Rate; Heart Ventricles; Hemodynamics; Heroin; Humans; Intracranial Pressure; Male; Pulmonary Artery; Pulmonary Edema

Pulmonary tissues from six patients who died with a clinical diagnosis of "heroin lung" (heroin-induced pulmonary edema) were examined with the light microscope and electron microscope. Immunofluorescent microscopic analysis revealed multifocal granular alveolar septal deposits of IgM in all patients, C3 complement in five patients, IgG in four patients, fibrinogen in three patients, and IgA in two patients. IgM, IgG, IgA, and C3 complement were eluted from the lungs of these addicts with citrate buffer with a low pH. No deposition of albumin was found in any of the specimens. These findings are believed to represent the first report of immune complexes in the alveolar capillary membrane in patients with heroin-induced pulmonary edema. Electron-microscopic studies revealed a proteinaceous plasma-like fluid in the alveolar spaces, thereby confirming the heroin induced pulmonary edema. Mechanisms of transport of edematous fluids from alveolar capillaries to alveolar spaces in lungs from heroin addicts are considered.

Topics: Adult; Complement C3; Female; Fibrinogen; Fluorescent Antibody Technique; Heroin; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Immunoglobulins; Lung; Male; Middle Aged; Pulmonary Edema

Topics: Adolescent; Adult; Brain Edema; Female; Hepatitis, Viral, Human; Heroin; Heroin Dependence; Humans; Male; Pulmonary Edema; Pulmonary Embolism

Both acute overdose reaction and near-drowning may present as pulmonary edema. With both, the heart is usually not enlarged and clearing occurs within 48 hours, unless complicated by infection or aspiration. In near-drowning there is metabolic acidosis, whereas in acute overdose reaction there is combined respiratory and metabolic acidosis.

Topics: Adult; Barbiturates; Carbon Dioxide; Cardiomegaly; Dextropropoxyphene; Diagnosis, Differential; Drowning; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; Middle Aged; Oxygen; Pulmonary Edema; Radiography; Substance-Related Disorders

An 18-year-old man developed acute pulmonary edema following heroin overdose. Two days after initial improvement, there was recurrence of hypotension and pulmonary edema with severe hypoxemia refractory to mechanical ventilatory support utilizing positive and end-expiratory pressure. Cardiac catheterization revealed elevated pulmonary capillary wedge pressure suggestive of left ventricular failure. The use of digitalis and diuretics resulted in prompt clinical improvement and ultimate recovery. Evidence is presented indicating that this patient represents an uncommon but important syndrome of acute cardiomyopathy with left ventricular failure which complicates the clinical course of certain cases of heroin overdose. Its physiologic diagnosis is of obvious importance in the choice of proper therapy, thereby increasing the patient's chances of recovery.

Topics: Acute Disease; Adolescent; Heart Diseases; Heart Failure; Heroin; Heroin Dependence; Humans; Hypotension; Male; Pulmonary Edema; Recurrence

We observed a patient who developed diffuse bronchiectasis subsequent to heroin-induced pulmonary edema. Unlike the previously reported cases, there was rapid clearing of pulmonary infiltrates and little evidence of severe aspiration. The development of bronchiectasis was attributed to a bronchial infection subsequent to clearing of the pulmonary edema. Physiologic dysfunction was characterized by marked obstruction, pulmonary hypertension, and mild hypoxemia.

Topics: Adult; Bronchiectasis; Heroin; Humans; Male; Pulmonary Edema; Respiratory Function Tests; Substance-Related Disorders

Their frequency is estimated with difficulty, although on autopsy pulmonary edema is found almost routinely. It is a major complication of overdoses (48 p. 100 of severe intoxications). Their formation can be suspected, when after the first phase of respiratory depressions, with coma, myosis, and a variable latent period, a second attack of respiratory insufficiency occurs with tachypnea, and cyanosis. The chest X-ray shows diffuse alveolar infiltration, sparing the apices. The heart being generally of normal size. Rapid disappearance of this infiltrate (24 to 48 hours) enables the elimination of two diagnoses: pneumonia due to inhalation of gastric fluid, an infectious pneumonia. Their pathogenesis remains very debatable: - in the majority of cases abrupt L.V.F. can be eliminated: -on the other hand it could be an allergic accident of the anaphylactic type, or local liberation of histamine, or a local toxic action on the pulmonary capillaries; - hypoxia, secondary to respiratory depression, could lead to pulmonary edema, by the same mechanism as at altitude; - finally, owing to the central neurological disorders a neurogenic theory can be put forward. Their treatment is essentially a combination of Nalorphine with oxygen therapy (by mask, or if necessary by assisted, controlled ventilation) with prevention of inhalation of gastric fluid (gastric emptying) or curative treatment of possible aspiration by antibiotics, and cortico-steroids. Diuretics can be useful, as well as cardiotonics.

Topics: Acute Disease; Hemodynamics; Heroin; Humans; Hypoxia; Pulmonary Edema

Severe heroin-induced pulmonary edema occurred in three previously healthy young men. Adequate arterial PO2 could only be achieved with the use of positive endexpiratory pressure (PEEP). Recovery was characterized by the gradual clearing of the pulmonary infiltrates and a gradual lessening of the severe restrictive ventilatory defects over many weeks. Concomitant aspiration of gastric acid was thought to be the explanation for the severity of these cases. In cases such as these, initial vigorous therapy, including PEEP for hypoxia, corticosteroids for possible aspiration and volume replacement for hypotension, is recommended.

Topics: Adrenal Cortex Hormones; Adult; Gastric Juice; Heroin; Humans; Hypotension; Hypoxia; Inhalation; Male; Positive-Pressure Respiration; Pulmonary Edema; Vital Capacity

Immediate attention must be given to the respiratory system of the heroin abuser; then he should be given naloxone HCl. Search for evidence of use of additional drugs, which may compound problems. Pulmonary edema, aspiration pneumonia and pulmonary embolization are the most common complications. Infections, particularly endocarditis, and cardiac arrhythmia also occur with heroin overdose. Hepatitis is common. Treatment must include not only attention to the presenting symptoms but also referral to a rehabilitation center when possible.

Topics: Arrhythmias, Cardiac; Chemical and Drug Induced Liver Injury; Dose-Response Relationship, Drug; Emergency Service, Hospital; Endocarditis; Female; Genital Diseases, Female; Heroin; Heroin Dependence; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infections; Male; Methadone; Naloxone; Pulmonary Edema; Respiratory Insufficiency

Topics: Adult; Diagnosis, Differential; Heroin; Humans; Male; Pulmonary Edema; Radiography

Topics: Heroin; Heroin Dependence; Humans; Pulmonary Edema

Topics: Acute Kidney Injury; Arrhythmias, Cardiac; Chemical and Drug Induced Liver Injury; Electrocardiography; Female; Fetal Diseases; Fetus; Heart Diseases; Hepatitis A; Heroin; Heroin Dependence; Humans; Hypertension, Pulmonary; Injections, Intramuscular; Injections, Intravenous; Injections, Subcutaneous; Lung Diseases; Male; Maternal-Fetal Exchange; Methods; Neurologic Manifestations; Pneumonia, Aspiration; Pregnancy; Pulmonary Edema; Pulmonary Embolism; Respiratory Insufficiency; Skin Diseases

Complications resulting from drug abuse more frequently affect the lung than any other organ. The spectrum of pulmonary complications associated with drug abuse is wide. The current practice of using mixtures of drugs is mainly responsible for the increase in pulmonary complications. The chief complications observed in a series of 241 drug abuse patients were aspiration pneumonitis (12.9 percent), pulmonary edema (10.0 percent), and pneumonia (7.5 percent).

Topics: Adult; Alcoholism; Barbiturates; Cannabis; Cocaine; Coma; Female; Heroin; Humans; Lung Abscess; Lung Diseases; Male; Pneumonia; Pneumonia, Aspiration; Pulmonary Atelectasis; Pulmonary Edema; Pulmonary Embolism; Pulmonary Fibrosis; Substance-Related Disorders

Topics: Adult; Bronchography; Drug-Related Side Effects and Adverse Reactions; Granuloma; Heart Valve Diseases; Heroin; Heroin Dependence; Humans; Hypertension, Pulmonary; Injections, Intravenous; Lung; Lung Diseases; Male; Narcotics; Pulmonary Edema; Respiratory Tract Infections; Sepsis; Substance-Related Disorders; Syringes; Talc; Tricuspid Valve; Tuberculosis, Pulmonary

Topics: Adolescent; Adult; Autopsy; Heroin; Humans; Iron; Lung; Male; Organ Size; Pulmonary Edema; Staining and Labeling; United States; Vietnam

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: Antihypertensive Agents; Bloodletting; Bronchodilator Agents; Digitalis; Digoxin; Furosemide; Heart Failure; Heroin; Hospitalization; Humans; Intensive Care Units; Mitral Valve Insufficiency; Mitral Valve Stenosis; Morphine; Oxygen Inhalation Therapy; Phytotherapy; Plants, Medicinal; Plants, Toxic; Positive-Pressure Respiration; Posture; Pulmonary Edema; Respiration, Artificial; Tourniquets; Venous Pressure

Topics: Female; Heroin; Humans; Male; Positive-Pressure Respiration; Pulmonary Edema

Topics: Heroin; Humans; Hypoxia; Lung; Pulmonary Edema; United States

Topics: Emergencies; Heroin; Heroin Dependence; Humans; Nalorphine; Naloxone; Pulmonary Edema; Respiratory Insufficiency; Substance-Related Disorders

Topics: Heroin; Humans; Nalorphine; Naloxone; Pulmonary Edema; Respiration; Respiratory Insufficiency; Substance-Related Disorders

Topics: Acidosis; Acidosis, Respiratory; Airway Obstruction; Carbon Dioxide; Heroin; Humans; Hypercapnia; Hypothyroidism; Hypoventilation; Hypoxia; Lung Diseases, Obstructive; Neuromuscular Diseases; Oxygen; Pulmonary Alveoli; Pulmonary Circulation; Pulmonary Edema; Pulmonary Embolism; Respiration; Respiratory Insufficiency; Ventilation-Perfusion Ratio; Work of Breathing

Topics: Acute Kidney Injury; Adult; Biopsy; Electromyography; Heroin; Humans; Leg; Male; Morphine Dependence; Muscles; Muscular Diseases; Myoglobinuria; Pulmonary Edema

Topics: Adolescent; Adult; Age Factors; Aged; Autopsy; Female; Forensic Medicine; Heroin; History, 20th Century; Humans; Injections; Malaria; Male; Middle Aged; Morphine Dependence; New York City; Pulmonary Edema; Quinine; Racial Groups; Sex Factors; Substance-Related Disorders; Thrombophlebitis; Urban Population

Topics: Adult; Autopsy; Carbon Dioxide; Female; Heroin; Humans; Lung Compliance; Oxygen; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Pulmonary Edema; Radiography; Respiration; Spirometry

Topics: Adolescent; Atrial Fibrillation; Blood Gas Analysis; Blood Pressure; Female; Heroin; Humans; Hypoxia; Intubation, Intratracheal; Levallorphan; Male; Nalorphine; Naloxone; Pneumonia, Aspiration; Positive-Pressure Respiration; Pulmonary Edema; Pupil; Respiration; Substance-Related Disorders

Topics: Adolescent; Adult; Age Factors; Antigens; Autopsy; Black or African American; Female; Florida; Hepatitis B; Hepatomegaly; Heroin; Humans; Hyperplasia; Liver; Lung; Lymph Nodes; Male; Mononuclear Phagocyte System; Morphine Dependence; Needles; Pulmonary Edema; Sex Factors; Spleen; Splenomegaly; Substance-Related Disorders

Topics: Adult; Anesthesia; Cellulitis; Female; Hepatitis A; Heroin; Humans; Male; Maternal-Fetal Exchange; Menstruation Disturbances; Physician-Patient Relations; Pregnancy; Pulmonary Edema; Substance-Related Disorders; Surgical Procedures, Operative; Tetanus

Topics: Adolescent; Adult; Cellulitis; Death Certificates; Ethnicity; Female; Hepatitis; Heroin; Hospitalization; Humans; Injections, Intravenous; Male; Middle Aged; Morphine; Narcotics; New York City; Pulmonary Edema; Seasons; Substance-Related Disorders

Topics: Altitude; Brain Injuries; Central Nervous System Diseases; Heart Failure; Heroin; Humans; Hypoxia; Pulmonary Edema; Shock; Substance-Related Disorders

Topics: Acidosis; Acidosis, Respiratory; Adolescent; Adult; Carbon Dioxide; Coma; Female; Heroin; Humans; Hypoventilation; Hypoxia; Lung; Lung Compliance; Male; Pulmonary Alveoli; Pulmonary Circulation; Pulmonary Diffusing Capacity; Pulmonary Edema; Pulmonary Ventilation; Radiography; Respiration; Spirometry; Substance-Related Disorders; Vital Capacity

Topics: Acute Disease; Adolescent; Adult; Autopsy; Bronchopneumonia; Codeine; Heroin; Humans; Male; Nasal Mucosa; Olfactory Mucosa; Pulmonary Edema; Substance-Related Disorders

Topics: Acute Disease; Adolescent; Adult; Autopsy; Chemical and Drug Induced Liver Injury; Female; Hepatitis A; Hepatitis B; Heroin; Humans; Liver; Liver Diseases; Lymph Nodes; Male; Morphine Dependence; Necrosis; Pulmonary Edema

Topics: Adult; Bronchi; Bronchiectasis; Female; Gastroesophageal Reflux; Heroin; Humans; Lung; Pneumonia, Aspiration; Pulmonary Edema; Trachea

Topics: Blood Proteins; Capillary Permeability; Coronary Disease; Exudates and Transudates; Heroin; Humans; Intubation, Intratracheal; Oxygen; Proteins; Pulmonary Edema; Serum Albumin; Substance-Related Disorders

Topics: Heroin; Humans; Methadone; Pulmonary Edema; Substance-Related Disorders

Topics: Adult; Heroin; Heroin Dependence; Humans; Male; Military Medicine; Pulmonary Edema; Substance-Related Disorders

Topics: Acute Disease; Adolescent; Adult; Atrial Fibrillation; Heroin; Humans; Male; Morphine Dependence; Poisoning; Pulmonary Edema

Topics: Adult; Blister; Clinical Enzyme Tests; Coma; Diagnostic Errors; Heroin; Humans; Male; Pulmonary Edema; Sepsis

Topics: Animals; Dogs; Hemodynamics; Heroin; Pulmonary Circulation; Pulmonary Edema

Topics: Adolescent; Adult; Anti-Bacterial Agents; Arrhythmias, Cardiac; Black or African American; Body Temperature; Coma; Drug Combinations; Ethnicity; Female; Heroin; Humans; Hypoxia; Male; Nalorphine; New York City; Pneumonia; Puerto Rico; Pulmonary Edema; Retrospective Studies; Substance-Related Disorders

Topics: Acute Disease; Administration, Oral; Adult; Coma; Female; Furosemide; Heroin; Humans; Hydrocortisone; Injections, Intravenous; Intubation, Intratracheal; Methadone; Nalorphine; Oxygen Inhalation Therapy; Penicillin G; Pulmonary Edema; Radiography; Substance-Related Disorders; Time Factors

Topics: Adult; Coma; Female; Hepatitis B; Heroin; Humans; Male; Osteomyelitis; Pulmonary Edema; Sepsis; Substance-Related Disorders

Topics: Adult; Coma; Heroin; Humans; Male; Positive-Pressure Respiration; Pulmonary Edema; Radiography; Shock, Septic; Substance-Related Disorders

Topics: Adult; Aneurysm; Aneurysm, Infected; Endocarditis, Bacterial; Female; Heroin; Humans; Hypertension, Pulmonary; Injections, Intravenous; Lung Diseases; Male; Methylphenidate; Middle Aged; Pneumonia; Pneumonia, Aspiration; Pulmonary Edema; Pulmonary Embolism; Radiography; Substance-Related Disorders; Thrombophlebitis; Thrombosis; Tuberculosis, Pulmonary; Vascular Diseases

Topics: Acute Disease; Adolescent; Adult; Chemical and Drug Induced Liver Injury; Duodenal Ulcer; Female; Heart Failure; Heroin; Humans; Jaundice; Male; Maryland; Middle Aged; Neurotic Disorders; Pneumonia; Pulmonary Edema; Pulmonary Fibrosis; Radiography; Sarcoidosis; Substance-Related Disorders; Tetanus

Topics: Adolescent; Adult; Chronic Disease; Heroin; Humans; Lung; Lung Diseases; Male; Pulmonary Edema; Respiratory Function Tests; Substance-Related Disorders

Topics: Adolescent; Adult; Female; Heroin; Humans; Injections; Lung; Lung Abscess; Male; Morphine Dependence; New York City; Pleural Effusion; Pneumonia; Pseudomonas Infections; Pulmonary Edema; Radiography; Spondylitis; Substance-Related Disorders; Tetanus; United States

Topics: Heroin; Humans; Morphine Dependence; Pulmonary Edema

Topics: Anti-Inflammatory Agents, Non-Steroidal; Heroin; Humans; Hypnotics and Sedatives; Pulmonary Edema