Sacro-iliitis in a heroin addict

A case is presented of a pregnant heroin addict patient, with a septic sacro-iliitis due to Staphylococcus aureus. The incidence of joint infections in heroin addicts and the difficulty of diagnosis is discussed with the potential risks of spinal or extradural anaesthesia when there is infection in joints close to the needle site. Caution is advised with patients addicted to heroin who have low back pain and may have infectious sacro-iliitis.     

海洛因依赖多药滥用患者心理状况调查分析

目的了解海洛因依赖多药滥用患者的心理状况,为正确制定护理措施提供依据。方法采用SCL 90症状自 评量表及自编药物滥用筛查表对61例海洛因依赖多药滥用患者进行调查,评估其心理健康状况,调查多药滥用的 原因及药物获取途径。结果海洛因依赖患者SCL 90总分及各因子分显著高于国内成人常模(P<0.05,P< 0.01),其中海洛因依赖多药滥用患者的分值均显著高于单纯海洛因依赖患者(均P<0.01);多药滥用的原因主要 为替代海洛因使用,促进睡眠或增加欣快感;药物获取途径主要为自行购买(药店或黑市)。结论海洛因依赖多药 滥用患者的心理健康状况较差,应针对性地进行心理支持及宣传教育。     

Gonadal function in male heroin and methadone addicts

Gonadal function was elevated in 80 male heroin and/or methadone addicts by measuring basal plasma levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) and testosterone. In 41 subjects semen analyses were also undertaken. Three groups were distinguished consisting of 15 heroin addicts, 42 undergoing methadone treatment but continuing to take heroin, and 23 taking only methadone. All patients had normal plasma levels of FSH, LH and testosterone. Prolactin levels were normal in all subjects except for the 15 heroin addicts, in whom they were significantly higher than in controls (P less than 0.025). Semen analyses from all of the heroin addicts and from the dual heroin-methadone users were abnormal, whereas only 10 out of 22 (45%) of the methadone takers were pathological. In all cases asthenospermia was one of the abnormalities (100%). Twenty-four per cent also showed teratospermia and hypospermia and 17% showed oligozoospermia. Such seminal pathology, especially of forward motility, even in combination with normal hormone levels, might be an early indication of heroin toxicity to the male reproductive tract.     

Nephropathy associated with heroin abuse in Caucasian patients.

BACKGROUND: Renal disease is a complication of heroin addiction. Using renal biopsies in Caucasian patients, we studied the types of nephropathy associated with heroin abuse. METHODS: Nineteen renal biopsies were performed on heroin addicts between January 1993 and December 2001. The indications for renal biopsy included proteinuria with or without renal insufficiency. RESULTS: All 19 patients had serological evidence of hepatitis C virus (HCV) infection, one had hepatitis B virus surface antigen and three were HIV positive. Thirteen patients (68.4%) were found to have membranoproliferative glomerulonephritis (MPGN), 12 with type I and one with type III. Of the remaining patients, two had chronic interstitial nephritis, two had acute proliferative glomerulonephritis, one had amyloidosis and one had granulomatous glomerulonephritis with interstitial nephritis. No apparent decline in the incidence of renal disease was observed. CONCLUSIONS: In this cohort of male Caucasian heroin addicts, HCV-associated MPGN was the most frequent pattern of nephropathy, showing that the nephropathy associated with heroin abuse in Caucasians is not of the focal and segmental glomerulosclerosis type, in contrast to previous reports on African-Americans. This aspect may have important implications for patient management and prognosis.     

海洛因依赖者的精液分析研究

对３０名男性海洛因依赖者（下称吸毒组）进行吸毒史调查,并进行精液常规分析及生化分析,与３０名正常男性精液作对照。结果表明,与对照组相比吸毒组精液量减少（Ｐ＜０．０５）,精子计数减少（Ｐ＜０．０１）,精子活力减低（Ｐ＜０．０１）,活动率降低（Ｐ＜０．０１）,且精子活力与吸毒总量、精子计数与吸毒总量均呈负相关关系（ｒ１＝－０．８３,ｒ２＝－０．６３）。吸毒组精浆果糖浓度降低（Ｐ＜０．０１）。精浆锌、钙浓度低下（Ｐ＜０．０５）,而精浆铁浓度明显升高（Ｐ＜０．０１）。精液涂片观察发现吸毒组精子畸形率明显高于对照组。结果表明海洛因依赖可导致男性精液质与量发生明显异常改变。     

Septic arthritis due to pseudomonas in heroin addicts.

Ten cases of septic arthritis due to Pseudomonas occurred in users of heroin. Nine cases were monarticular, two each occurring in the sternoclavicular and the sacro-iliac joints. Review of the literature suggests that the incidence of Pseudomonas septic arthritis is increasing, especially among heroin addicts. The reported cases in adults suggest a predilection for the sternoclavicular joints (eight of forty-one) which is even more pronounced among addicts (seven of twenty-four). Pseudomonas infection associated with drug abuse should be suspected in cases of isolated sternoclavicular inflammation. The drugs used for treatment of septic arthritis due to Pseudomonas should include gentamicin and carbenicillin, in conjunction with adequate drainage by aspiration or surgery.     

Safety, efficacy, and long-term results of a modified version of rapid opiate detoxification under general anaesthesia: a prospective study in methadone, heroin, codeine and morphine addicts

BACKGROUND: In the present study a method of rapid opiate detoxification under general anaesthesia has been evaluated regarding the safety, the efficacy in preventing withdrawal symptoms, and the long-term results. In addition, it was investigated whether the profile and severity of withdrawal symptoms depend on the type of opiate abused (methadone, heroin, codeine, morphine). METHODS: Seventy-two opiate addicts were detoxified in an intensive care unit (ICU). Anaesthesia was induced and maintained using propofol infusion. Patients were endotracheally intubated. The opiate receptor antagonist naltrexon was administered into the stomach via a nasogastric tube. Withdrawal symptoms before and after the detoxification treatment were assessed using an objective and a subjective opiate withdrawal scale (OOWS, SOWS). After detoxification patients entered a long-term naltrexone maintenance programme as well as a supportive psychotherapy programme. Vital organ function was monitored using haemodynamic and respiratory parameters as well as body temperature. RESULTS: Organ function parameters were stable during the whole treatment in all patients and no anaesthetic complications were registered. Minor side effects such as bradycardia or hypotension were observed in 20 patients. Compared to patients with pre-existing heroin, codeine, or morphine abuse respectively, patients from the methadone maintenance programme had significantly higher (P<0.01) OOWS as well as SOWS values after the treatment. Twelve months after the detoxification 49 patients (68%) were abstinent from opiates whereas 17 patients had relapsed during the period of follow-up. Six patients were lost during follow-up. CONCLUSIONS: Rapid opiate detoxification under general anaesthesia is a safe and efficient method to suppress withdrawal symptoms. This treatment may be of benefit in patients who particularly suffer from severe withdrawal symptoms during detoxification and who have failed repeatedly to complete conventional withdrawal. Methadone patients have more withdrawal symptoms than other opiate addicts.     

Impulse control differences between abstinent heroin users and matched controls

Objective : Heroin use has been associated with increased impulsive behaviour. This study examined the lasting effect of heroin use on impulse control in a group of ex-heroin addicts.

Research design and method : Twenty-eight men, 14 ex-heroin addicts and 14 matched controls, participated in this study. The impulse control ability between the two groups was compared. Each participant was individually interviewed for demographic data and testing of their impulse control ability using the Porteus Maze Test.

Results : The findings indicated that the ex-heroin addicts performed significantly more poorly on the measure of impulse control than the matched controls.

Conclusions : This observation suggests that the adverse effect of heroin on impulse control may be long lasting. Alternative explanations for the findings were also discussed.     

Primary phycomycosis of the brain in heroin addicts

Two heroin addicts had fatal primary phycomycosis of the brain. The first case is unique. A 28-year-old man displayed unusual symptoms of unilateral hydrocephalus confirmed by both computed tomography (CT) scanning of the brain and craniotomy. The nature of the fungal granuloma was verified histopathologically. The second case, a 40-year-old man, possessed bilateral basal ganglionic lesions in which the CT scanning suggested abscesses. Postmortem examination confirmed the presence of phycomycotic abscesses. There was no evidence of systemic mycoses in both cases. Review of the clinical features of this fatal complication in drug abusers and narcotic addicts disclosed that hemiparesis and facial weakness are common. Brain or CT scan along with brain biopsy are necessary for rapid diagnosis and prompt treatment.     

204名吸毒者骨钙含量调查

本文对２０４名吸毒者（海洛因）进行了骨钙含量的测定，旨在探讨吸毒与人体健康的关系。仪器采用国产ＳＤ－２００型单光子骨矿仪，桡尺骨常规部位测定。实验按男女每５岁分组，与昆明地区正常值比较。结果：①桡尺骨男性３０～３４岁组与正常值比较差异有显著性。②男性２５～２９、３０～３４岁两组中吸毒时间１～２年组较０～１年组低，差异有显著性。③日吸毒剂量＞０．６克组与＜０．５克组之间差异有显著性。提示吸毒对人体骨钙的增加具有不利的作用，日吸毒剂量增加对骨钙减少具有明显的影响     

Candida albicans costochondritis in heroin addicts

The dramatic increase in the number of heroin addicts has led to an increase in the number of infective complications seen, especially those due to Pseudomonas aeruginosa and Candida albicans. In this report we describe our current experience in the surgical treatment of Candida albicans costochondritis. The clinical picture, diagnostic techniques, and surgical therapy receive comment, and a brief review of the literature is given.     

Epidemic of fatal estivo-autumnal malaria: Among drug addicts in New York City transmitted by common use of hypodermic syringe

The epidemiological, clinical and pathological findings in an epidemic of fatal estivo-autumnal malaria of the cerebral type occurring in drug addicts in New York City are reported. The disease was directly transmitted from addict to addict as a result of the common practice of sharing the use of unsterilized hypodermic syringes for intravenous injections of heroin.     

Membranous glomerulonephritis may be associated with heavy marijuana abuse

It is well documented that drug abuse can cause renal diseases. Nephropathy and proteinuria among heroin addicts has been recognized since the early 1970s. The predominant lesions in heroin-associated nephropathy are segmental glomerulosclerosis in African-Americans and membranous glomerulonephritis (MGN) in the Caucasian population. Cocaine may induce kidney damage, predominantly acute renal failure in the course of rhabdomyolysis. However, there are no case reports of nephropathy associated with marijuana smoking. We report a case of a marijuana-addicted 27-year-old Caucasian man after cadaveric kidney transplantation who developed de novo posttransplant MGN. The long period and high level of narcotic intoxication suggested that de novo MGN may have been associated with heavy marijuana abuse.     

Respiratory failure in a HIV seropositive heroin addict female

A 31-year-old woman, heroin addict since ten years, and infected by the human immunodeficiency virus (HIV) since one year, was admitted to the intensive care unit for respiratory failure (PaO2 = 40 mmHg and PaCO2 = 14.8 mmHg, despite breathing pure oxygen). She had been followed up for 6 months for increasing dyspnoea due to chronic cor pulmonale for which no satisfactory explanation had been put forward. Artificial ventilation with 8 cmH2O positive end-expiratory pressure and 100% oxygen was completely inefficient. She died within a few hours. Postmortem lung biopsy revealed talc particles within interalveolar walls and alveolar macrophages as well as the expected alterations in blood vessels. Pulmonary hypertension due to talc microemboli is a well-known cause of respiratory failure in heroin addicts. Such a diagnosis should not be overlooked in a patient infected with HIV. Respiratory failure may not be only due to opportunist infections, or tumours related to the HIV infection.     

Chronic sclerosing glomerulopathy (heroin-associated nephropathy) in intravenous T's and Blues abusers

The intravenous (IV) use of pentazocine (Talwin) and tripelennamine (pyribenzamine) has become a major form of drug abuse seen in the midwestern United States. Complications of this abuse have included psychotic reactions, acute pulmonary insufficiency, convulsions, and various infections. We have observed three patients in whom the IV use of these agents was associated with the nephrotic syndrome and renal histopathologic findings similar to that reported in heroin addicts with the so-called "heroin-associated nephropathy." Percutaneous renal biopsy demonstrated focal to diffuse segmental or global glomerulosclerosis by light microscopy. Electron microscopy revealed glomerular visceral epithelial cell foot process effacement and microvillus formation. Immunofluorescent studies were negative in the two patients studied. One patient presented in renal failure, and two others progressed to renal failure within 3 years of diagnosis. We suggest the term opiate nephropathy for this lesion in narcotics users, indicating its potential occurrence in non-heroin-using drug addicts.     

Right-sided bacterial endocarditis. New concepts in the treatment of the uncontrollable infection

Our experience with 25 patients with right-sided bacterial endocarditis is described; 23 were heroin addicts. The clinical manifestations of right-sided endocarditis are primarily related to septic pulmonary embolism.When the infection was due to gram-positive cocci, antibiotics always cured the patient. However, if the infection was due to Pseudomonas aeruginosa resistant to therapy, excision of the infected tricuspid or tricuspid and pulmonary valves without prosthetic replacement effected a cure. Nine out of 10 long-term survivors treated in this manner have had no significant hemodynamic difficulties.Antibiotic therapy must be limited to six weeks or less, because if the infection persists beyond this period it may also spread to the left side of the heart, where valve excision without replacement is impossible.     

滥用海洛因合并感染性心内膜炎及急性肾损伤

目的探讨海洛因依赖者感染性心内膜炎合并急性肾损伤的临床特点及预后。方法海洛因依赖者6例,年龄32-46岁,均为男性,均有静注海洛因史,吸毒年限2～10年。行尿吗啡定性、尿蛋白定量、肝功能、肾功能、免疫功能、丙型肝炎病毒抗体、乙型肝炎病毒表面抗原、血培养、心脏彩超及肾活检检查,予抗感染治疗,比较治疗前、后各项指标的变化。结果6例患者均表现为血象升高、贫血、血尿、蛋白尿、低蛋白血症、血肌酐升高、低补体血症、C-反应蛋白升高。丙型肝炎病毒抗体阳性5例,乙型肝炎病毒表面抗原阳性2例,血培养示金黄色葡萄球菌3例。6例患者心脏彩超均示三尖瓣前瓣赘生物形成。肾脏病理表现为中度系膜增生性肾小球肾炎、新月体性肾炎各2例,IgA肾病、毛细血管内增生性肾炎各1例。经治疗后病情均好转,血象、尿蛋白、尿素氮、肌酐明显下降,血清白蛋白明显上升,贫血、肝功能无明显变化。结论滥用海洛因可导致感染性心内膜炎并发肾小球肾炎,常合并肾病综合征、急性肾损伤,病理类型多样。经抗感染治疗后尿蛋白、肾功能明显好转。     

Low back pain due to neisseria prostatitis: report of three cases.

After a short term of employment in a new job, 3 young heroin addicts became disabled from low back pain due to neisseria gonorrhea prostatitis. Each returned to work after a few weeks of antibiotic therapy without symptoms following proper diagnosis. These patients demonstrate the importance of a careful history and thorough examination of the patient with low back pain including a rectal examination of the prostate gland.     

Systemic candidiasis]

Candida proliferate within the body of patients with deficient cellular immunity either by the haematogenous route or by adjacency. This condition is often found in hospital patients. It explains the increasing incidence of disseminated candidiasis. They are preferentially found in patients who have had complicated surgery, mostly of the gastrointestinal tract and the heart, or transplant surgery (except for kidney transplants), or who have had prolonged intensive care. Other patients concerned are neonates with a low birth weight, haemato-oncology patients, heroin addicts and AIDS patients. Clinical signs are usually unspecific. When there is widespread involvement, clinical signs can be defined by the secondary locations, especially within the kidneys, lung, endocardium and brain in surgical patients, and liver and spleen in haemato-oncology patients. Eye, skin, gastrointestinal tract, and indeed, muscle lesions which are easily accessible, should be looked for routinely. This helps to ascertain the diagnosis, by showing the presence of Candida in the tissues. Moreover, isolating Candida from places which are normally sterile confirms deep-seated candidiasis. However, the presence of Candida in urine, bronchi, or drainage fluids is only the witness of saprophytism. This underlines the usefulness of immunological tests, which should soon benefit from the availability of new kits for the detection of cytoplasmic antigens. Indeed, the search for antibodies or circulating metabolites do not provide, at present, significantly different results in patients who have only been colonised and in those who have a systemic candidiasis. Interesting results are only obtained by showing the presence of mannans, in research laboratories. For treatment, amphotericin B remains the standard antifungal agent, and the association of amphotericin B with flucytosine the recommended association. However, drugs such as the new triazoles, among which fluconazole is particularly well tolerated and efficient, may considerably alter the principles of treatment. Finally, combining a fungal decontamination of the gut should help reduce the very high death rate of systemic candidiasis.     

Surgical Treatment of Primary Sternal Osteomyelitis

Four patients with primary sternal osteomyelitis are described. Pseudomonas aeruginosa was the infective organism. Three of the 4 were heroin addicts. Limited surgical resection with preservation of the posterior periosteum is recommended for an infected sternum. Postoperative antibiotic therapy for a period of six weeks is also recommended. Preservation of the posterior sternal periosteum rather than conventional radical excision is important for maintaining physical stability and avoiding chest wall deformity in this group of patients.