Painful and petechial rash after injecting black tar heroin

Abstract

A painful petechial rash developed in a patient after the subcutaneous or intravenous injection of reported black tar heroin. Additional history and the appearance of the skin lesion suggested otherwise.     

Wound Botulism Associated with Black Tar Heroin

The incidence of wound botulism is increasing and the epidemiology of the disease is changing. The majority of new cases are associated with injection drug use, in particular, the use of Mexican black tar heroin. This case report and discussion of wound botulism illustrate the following important points: Dysphagia, dysphonia, diplopia, and descending paralysis, in association with injection drug use, should alert the treating physician to the possibility of wound botulism. In such patients, the onset of respiratory failure may be sudden and without clinically obvious signs of respiratory weakness. For the reported patient, maximum inspiratory force measurements were the only reliable indicator of respiratory muscle weakness. This is a measurement not routinely performed in the ED, but may prove essential for patients with suspected wound botulism. To minimize the effect of the botulinum toxin and to decrease length of hospital stay, antitoxin administration and surgical wound debridement should be performed early.     

Morbidity associated with heroin overdose presentations to an emergency department: A 10‐year record linkage study

Introduction: To examine hospitalizations in a cohort of 224 patients who presented with non‐fatal heroin overdose to an ED. Methods: A record linkage study, using the morbidity, mental health and mortality databases in the Data Linkage Unit of the Department of Health, Western Australia. The main outcome measures were hospital separations 5 years before and after entry into the cohort. Results: Before entry into the cohort, 199 (89%) patients had an admission to mental health services. These 199 had a combined total of 1367 separations, most commonly for a mental health condition, injury or poisoning. Women had more than twice the relative risk (RR) of men for all separations (RR 2.35, 95% confidence interval [CI] 1.96–2.82, P < 0.001) and for injury and poisoning separations (RR 2.04, 95% CI 1.56–2.66, P < 0.001). The highest concentrations of separations occurred within 1 year before and 1 year after entry into the cohort. There were 12 (5.4%, 95% CI 2.9–9.4%) deaths, most commonly from overdose. Conclusion: Non‐fatal heroin overdose ED presentations are associated with a cluster of hospitalizations around that episode, likely to be related to heroin availability. Presentation to hospital by heroin users represents an opportunity to counsel less risky behaviour.     

Psychiatric co-morbidity among subjects with heroin and cocaine use disorders and its association with HCV infection

Abstract

Aim: This study aims to determine whether psychiatric co-morbidity is associated with HCV infection in a substance misuse population.

Methods: We identified all subjects in the National Drug Treatment Monitoring System (NDTMS) during the period January 2007–December 2010 for whom information was recorded which identified their psychiatric co-morbidity status and their HCV status. Multivariate analysis was used to identify risk factors that could predict HCV infection.

Results and conclusions: The HCV prevalence rate was 32%. HCV infected subjects were younger (21.4% versus 23.1%) when they first started to use drugs, they were more likely to be white (85.1% versus 13.1%) and male (74% versus 72.6%), to have urgent housing problems (13.0% versus 9.7%), to inject (42.8% versus 18.8%), and to share injecting paraphernalia (35.4% versus 9.2%). After adjusting for demographics and drug and alcohol use behaviours, the Odds Ratio of psychiatric co-morbidity for HCV infection was 1.33 (95% CI 1.01–1.75). The results suggest that psychiatric co-morbidity is associated of HCV infection.

Clinical implications: It is important to take psychiatric co-morbidity into account when treating these patients and designing intervention strategies.     

氧化锌油加地塞米松治疗糜烂创面临床观察

采用氧化锌油加地塞米松对５６例不同伤口进行治疗，治疗２次～１２次后，伤口痊愈。     

负压伤口治疗时两种填充敷料对伤口床温度和渗液酸碱度的影响

目的比较实施负压治疗时纱布和泡沫填充敷料对伤口床温度(伤口温度和伤口周围皮肤温度)和渗液酸碱度的影响,以筛选更合理有效的填充敷料。方法便利抽样法选择2009年10月至2011年3月在南京军区南京总医院门诊伤口护理中心治疗的20例患者为研究对象,按入院时间的先后将其分为A、B两组,每组10例。A组患者采用泡沫敷料,B组患者采用纱布作为填充敷料实施负压治疗,两组患者均给予智能化吸引装置,其压力值和吸引模式均相同。两组在治疗前及治疗后7、14、21d使用相同方法测量伤口床温度及渗液pH,并比较两组患者治疗3周后的平均伤口缩小率、治愈率及愈合时间。结果敷料干预主效应、敷料干预与治疗时间交互效应,两种填充敷料实施负压治疗前和后21d内渗液pH变化、伤口温度和周围皮肤温度差异均无统计学意义(均P>0.05);治疗时间主效应、负压治疗前和后21d内渗液pH差异均无统计学意义(均P>0.05),但伤口温度随治疗时间延长有明显升高(P<0.05)。结论纱布和泡沫敷料作为填充敷料实施负压伤口治疗对伤口床温度及渗液pH作用相当,均可以作为负压治疗的有效敷料。     

海洛因依赖者的脑CT表现及不同戒毒治疗方法的疗效研究

目的了解海洛因依赖者脑CT表现及不同戒毒治疗方案的疗效。方法对72例海洛因依赖者与50例正常对照者的脑CT表现进行对照研究,分析不同戒毒治疗方法的效果。结果部分海洛因依赖者内囊后肢、丘脑及侧脑室周围脑白质、小脑齿状核CT值有不同程度的减低(P0.05);提示海洛因依赖者可能有脑实质损害,此损害与吸毒时间长短、吸毒量多少无显著性差异;海洛因依赖者采用单独美沙酮戒毒治疗和综合治疗的效果有显著性差异。结论海洛因依赖者的戒毒治疗应考虑脑实质损害,辅以营养脑细胞、修复脑损害、恢复脑功能等综合性治疗手段。     

Comparison of Patient Satisfaction and Practitioner Satisfaction with Wound Appearance after Traumatic Wound Repair

Introduction : Existing cosmetic scales for wounds are based only on practitioners' evaluations. They have not been validated using the patient's assessment.
Objective : To validate a previously developed wound cosmesis scale by determining the relationship between patient and practitioner assessments of cosmetic outcome following traumatic wound repair. Methods : A convenience sample of patients with lacerations repaired in an ED were evaluated at the time of suture removal. Practitioners assigned 0 or 1 point each for the presence or absence of a step-off of borders; contour irregularities; margin separation; edge inversion; excessive distortion; and overall appearance. A total cosmetic score was calculated by adding the categories above. As previously defined, a score of 6 was considered optimal; < s6 was considered "suboptimal." Patients, blinded to the physician score, assessed their degrees of satisfaction with the cosmetic outcome of the wounds using a 100-mm visual analog scale (VAS). Because VAS scores were not normally distributed, practitioner scores were compared with patient satisfaction scores using a Mann-Whitney U test.
Results : 125 patients were enrolled, of whom 64% were male; the median age was 19.5 years (interquartile range = 8–33 years). Wounds were located predominantly on the face, scalp, or neck (47%) and upper extremity (35%), and had a median length of 2 cm. The 86 lacerations given optimal practitioner scores had a median patient satisfaction score of 97 mm; the 39 "suboptimal" lacerations had a median patient satisfaction score of 87 mm (p = 0.0006).
Conclusion : Lacerations that practitioners ponsidered to have optimal cosmetic appearances at the time of suture removal received higher patient satisfaction scores than did lacerations considered to be suboptimal. This provides a measure of validity to this 6-item categorical cosmetic scale.     

Adipokines are associated with lower extremity venous disease: the San Diego population study

Summary. Background: Obesity is a risk factor for venous disease. We tested the associations between adipokines and the presence and severity of venous disease. Methods: Participants for this analysis were drawn from a cohort of 2408 employees and retirees of a university in San Diego who were examined for venous disease using duplex ultrasonography. From this cohort, a case‐control study sample of all 352 subjects with venous disease and 352 age‐, sex‐ and race‐matched subjects without venous disease were included in this analysis. All subjects completed health history questionnaires, had a physical examination with anthropometric measurements and had venous blood analyzed for adipokines. Results: After adjustment for age, sex and race, those with venous disease had significantly higher levels of body mass index (BMI), leptin and interleukin‐6. Levels of resistin and tumor necrosis factor‐alpha were also higher but of borderline significance (0.05 < P < 0.10). Compared with the lowest tertile and with adjustment for age, sex, race and BMI, the 2nd and 3rd tertiles of resistin (odds ratios, 1.9 and 1.7, respectively), leptin (1.7 and 1.7) and tumor necrosis factor‐alpha (1.4 and 1.7) were associated with increasing severity of venous disease. Conversely, a 5 kg m^?2 increment in BMI was associated with a higher odds ratio (1.5) for venous disease, which was independent of the adipokines included in this study. Conclusions: Both obesity and adipokines are significantly associated with venous disease. These associations appear to be independent of each other, suggesting potentially different pathways to venous disease.     

下肢动脉血栓的机械性祛栓结合药物溶栓治疗

目的：研究OASIS导管流变溶栓和Amplatz血栓消融导管（Amplatz Thrombectomy Device，ATD）浸软溶栓结合基因重组型人组织纤溶酶原激活剂（recombinant human tissue-type plasminogen activator, rt-PA）或尿激酶（UK）药物溶栓治疗下肢动脉血栓形成的安全性和临床疗效。材料与方法：对18例下肢动脉血栓形成的患者实施急诊OASIS导管流变溶栓（12例）或ATD导管浸软溶栓（6例）术，对远端小血管残留血栓给予rt-PA溶栓2例，UK溶栓7例，对4例5处髂股动脉狭窄段采取经皮球囊扩张（Percutaneous TransLuminal Angioplasty, PTA）或支架成形辅助治疗。其中髂动脉3例，股动脉13例，腘动脉1例，股动脉、腘动脉、胫前胫后动脉及足部动脉广泛血栓形成1例。结果：18例机械性祛栓技术实施成功率100%，其中14例术中处理后立即完全再通；4例术后留置导管继续溶栓3～5天达到完全再通。其中4例5处动脉狭窄段采用球囊扩张或置入支架后狭窄段的血管腔平均复通率95%，临床表现好转率100%。全部病例均经DSA、B超及临床随访１～45个月，动脉均保持通畅。无血管穿孔并发症和截肢病例，溶栓过程中出现消化道出血1例。结论：采用OASIS导管和ATD导管机械性祛栓结合rt-PA或UK药物溶栓治疗能够快速地祛除下肢动脉血栓，安全性高，临床疗效显著。用PTA和支架辅助治疗可有效地解除动脉狭窄，防止血栓再形成，避免截肢。     

多孔敷料负压封闭治疗创面的观察和护理

目的 :观察负压封闭治疗创面的效果。方法 :采用多孔敷料负压封闭疗法 ,对不同深度及大小的急、慢性创面进行处理。结果 :经该方法处理创面后创面愈合时间 ,急性创面 1～ 3周 ,平均 2周 ;慢性创面 2～ 8周 ,平均 4周。结论 :多孔敷料负压封闭处理创面与传统方法相比较 ,具有操作简单、密闭好、创面愈合速度加快、降低交叉感染等优点     

MATRIX技术在急性下肢动脉硬化闭塞症诊断中的应用价值

目的 探讨磁共振超长回波链可变回聚脉冲反转角成像序列(modulated flip angle technique in refocused imaging with extended echo train,MATRIX)对下肢动脉硬化闭塞症(arteriosclerosis obliterans,ASO)的诊断价值,...     

海洛因及腺苷补偿对大鼠部分血浆生化指标影响的分析

目的研究海洛因依赖及腺苷补偿时大鼠肾功能生化指标的变化和意义。方法建立海洛因依赖及腺苷补偿组大鼠模型，50只Wistar大鼠随机分成对照组、3d给药组、9d给药组、腺苷对照组及同时给海洛因和腺苷9天组，检测血液生化指标尿素氮（BUN）、肌酐（CREA）及尿酸URIC）。结果与对照组相比，海洛因3天、9天给药组中URIC含量均明显升高（P〈0．01）。与海洛因给药9天组相比，同时给海洛因和腺苷组中URIC的血浆含量明显下降（P〈0．01）。结论海洛因对肾功能损害则较轻，在代偿范围内；同时给予腺苷能够维持血浆部分生化指标的相对稳定。     

骨折外固定加创面冲洗疗法的临床应用及护理

1992年12月至1995年6月，对38例四肢开放骨折并感染的患应用外固定架的同时行创面冲洗疗法，取得满意效果。总结治疗方法与护理体会如下：观察肢体局部变化及外固定架位置是否合适、及时调整外固定架，并准确使用有效抗生素冲洗液。对骨折并骨髓炎患行密闭式冲洗疗法，注意冲洗速度，拔管时间和拔管顺序。此方法手术创面小，便于早期活动，促进骨折愈合，避免关节僵直，大大缩短了住院时间。     

气性坏疽伴下肢截肢患者的护理

总结分析8例严重外伤导致气性坏疽伴下肢截肢患者的护理经验,包括入院后的急救处理、消毒和隔离、心理护理、截肢残端护理、氧疗护理等。认为全面系统规范的护理能促进患者的康复,改善临床救治疗效。     

Closed reduction of hip dislocation associated with ipsilateral lower extremity fractures: A case report and review of the literature

BACKGROUNDTraumatic hip dislocation usually occurs following high-velocity trauma. It is imperative that the dislocation be reduced in a timely manner, especially in a closed manner, as an orthopedic emergency. However, closed reduction can hardly be achieved in patients who also have ipsilateral lower extremity fractures. Herein, we focus on hip dislocation associated with ipsilateral lower extremity fractures, excluding intracapsular fractures (femoral head and neck fractures), present an early closed hip joint reduction method for this injury pattern, and review the literature to discuss the appropriate closed reduction technique for this rare injury pattern.CASE SUMMARYWe report a case of a 37-year-old male who sustained a left acetabular posterior wall fracture, an ipsilateral comminuted subtrochanteric fracture and dislocation of the hip. The hip dislocation was reduced urgently in a closed manner using the joy-stick technique with a T-shaped Schanz screw. The fractures were reduced and fixed as a 2nd-stage surgery procedure. At the 17-month postoperative follow-up, the patient had full range of motion of the affected hip.CONCLUSIONClosed reduction of a hip dislocation associated with ipsilateral lower extremity fractures is rarely achieved by regular maneuvers. Attempts at closed reduction, by means of indirectly controlling the proximal fracture fragment or reconstructing the femoral leverage rapidly with the aid of various external reduction apparatuses, were shown to be effective in some scenarios. Mandatory open reduction is indicated in cases of failed closed reduction, particularly in irreducible dislocations.     

成人海洛因成瘾HIV/AIDS合并肺结核患者CD4+T淋巴细胞计数与肺功能关系的研究

目的 研究成人海洛因成瘾HIV/AIDS合并肺结核患者CD4+ T淋巴细胞计数与肺功能的相关性.方法 对58例成人海洛因成瘾者HIV/AIDS合并肺结核患者做T细胞亚群(CD3+、CD4+、CD8+)与肺功能(SVC、FVC、FEV1-0、FEV1-0/FVC、FET25-75、FEF25、FEF50、FEF75、MM...     

急性和亚急性下肢DVT的超声鉴别诊断

目的探讨超声检查鉴别急性和亚急性下肢深静脉血栓(DVT)的可行性.方法经超声诊断的43例46条下肢DVT患者,根据其诱因和症状出现的时间分为急性组和亚急性组,比较两组血栓形成部位、回声特点及病变静脉管径.结果两组血栓的形成部位、回声特点有显著差别(P＜0.05),而管径无明显差别(P＞0.05).以低回声表现的局段性、周围型和中央型血栓诊断急性下肢DVT的特异性分别为100%、84.6%和75%.而以中回声表现的血栓和混合型血栓诊断亚急性下肢DVT的特异性分别为100%和86.9%.结论对于诱因及症状不明确的下肢DVT患者,根据超声检查多数可区别急性和亚急性DVT,但少数仍不能明确区分.