heroin and Respiratory-Distress-Syndrome

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

To determine whether there are factors during apparent rapid heroin overdose death that affect agonal state and thus brain pH (index of hypoxia) that can influence neurobiological systems linked to drug abuse.. Brain specimens and autopsy/medical reports were investigated in subjects dying from heroin overdose (n=70) and compared to normal controls (n=45) as well as suicide victims (n=31) with a documented rapid cause of death. Detailed autopsy material was characterized as to positive and negative respiratory distress in relation to brain pH; drug toxicity and other demographic information was also evaluated. In situ hybridization histochemistry was used to study mRNA expression levels of dopamine (e.g., D2 receptor, dopamine transporter) and opioid (e.g., proenkephalin) related markers in various structures in relation to brain pH.. Brain pH was generally reduced in heroin overdose cases versus normal and suicide subjects. There was, however, significant variation in heroin overdose deaths related to differences in respiratory distress that differentially altered brain pH levels. Various factors such as vomit inhalation, resuscitation, pulmonary embolism and suffocation contributed to positive respiratory distress. Elevated brain pH was observed in heroin overdose with positive alcohol toxicity suggesting potentiated alcohol-induced rapidity of heroin deaths. mRNA expression levels of the dopamine-related genes and proenkephalin were positively correlated with brain pH.. Respiratory distress contributes to variations in the acute agonal state during heroin overdose death that differentially alters brain pH levels and significantly impacts mRNA levels. Such findings should be considered for postmortem molecular/neurochemical neurobiological studies of opiate abusers.

Topics: Adolescent; Adult; Aged; Autopsy; Brain Chemistry; Central Nervous System Depressants; Drug Overdose; Enkephalins; Ethanol; Female; Heroin; Humans; Hydrogen-Ion Concentration; In Situ Hybridization; Male; Middle Aged; Prevalence; Protein Precursors; Receptors, Dopamine D2; Respiratory Distress Syndrome; RNA, Messenger; Suicide

The expression of intercellular adhesion molecule-1 (ICAM-1) in the pathogenesis of heroin-induced acute lung injury (ALI) in rats was investigated. The model of ALI was established by intravenous injection of heroin into tail vein in rats. Thirty-six rats were randomly divided into heroin-treated groups (1 h, 2 h, 4 h, 6 h and 24 h) and normal control group. Changes in histopathologic morphology and biological markers of ALI were measured. The expression of ICAM-1 in lung tissue was detected by using immunohistochemistry and RT-PCR. The results showed that the W/D ratio and protein contents in BALF of the heroin-treated groups were significantly higher than that of the, control group (P<0.01). The histopathological changes in the lung tissue were more obvious in heroin-treated groups. The ICAM-1 protein and mRNA expression in the lung tissue of heroin-treated groups were significantly increased as compared with that of the control group (P<0.01), and correlated with the ALI parameters in a time-dependent manner. Increasing of ICAM-1 expression was involved in the formation of heroin-induced lung injury. Furthermore, the level of expression was positively correlated with the severity of lung injury.

Topics: Animals; Heroin; Intercellular Adhesion Molecule-1; Male; Random Allocation; Rats; Rats, Wistar; Respiratory Distress Syndrome; RNA, Messenger

We report a case of acute respiratory distress syndrome (ARDS) and pulmonary granulomatosis after intravenous injection of heroin. This 46-year-old male had a 2-year history of heroin addiction. The recent admission was due to loss of consciousness after intravenous injection of diluted heroin with unknown filler. Initial chest X-ray revealed a picture of ARDS. Blood routine and biochemistry were normal except for leukocytosis. Urine morphine test was positive. The blood and sputum culture yielded no pathogens. After supportive treatment, his condition improved, and the follow-up chest X-ray showed diffuse micronodules in both lung fields. Subsequently, open-lung biopsy of the right upper and lower lobes on the 26th hospital day showed large amounts of foreignbody granulomas distributed over perivascular areas, bronchiolar areas and interstitium. Staining for bacteria, fungi, and mycobacteria was all negative. The morphology of foreign-bodies could be divided into 2 types: 1) periodic acid-Schiff (PAS)-positive, aggregated fine crystals in round form; and 2) PAS-negative, yellow long crystals. The pathological diagnosis of pulmonary granulomatosis was made based on the finding of filler foreign bodies. The nature of these foreign bodies remained undetermined. The case suggests that pulmonary granulomatosis with the radiographic appearance of chronic interstitial pneumonia can occur in patients with a history of heroin use.

Topics: Acute Disease; Drug Contamination; Granuloma, Foreign-Body; Heroin; Humans; Injections, Intravenous; Lung; Male; Middle Aged; Narcotics; Respiratory Distress Syndrome

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

A 14-year-old previously fit schoolboy was admitted with staphylococcal pneumonia secondary to influenza A infection. His condition deteriorated as he developed adult respiratory distress syndrome (ARDS); during a stormy recovery exceptionally high doses of benzodiazepines and opiates were given in order to suppress voluntary breathing during a successful period of assisted ventilation. It is possible that benzodiazepine-opiate antagonism developed. Subsequent studies in laboratory mice indicate that the respiratory depressant effects of morphine can be antagonized by prior treatment with lorazepam.

Topics: Adolescent; Animals; Anti-Anxiety Agents; Critical Care; Drug Interactions; Heroin; Humans; Lorazepam; Male; Mice; Morphine; Narcotic Antagonists; Respiratory Distress Syndrome