No abstract available.
Health Personnel/*ethics ; Humans ; Hypnotics and Sedatives/*adverse effects ; Propofol/*adverse effects ; Substance Abuse, Intravenous/*etiology

Endophthalmitis ; diagnosis ; etiology ; Humans ; Klebsiella pneumoniae ; pathogenicity ; Male ; Middle Aged ; Substance Abuse, Intravenous ; complications

INTRODUCTIONInjecting drug abusers are vulnerable to many infectious complications. We describe a case of tetanus in a Singaporean who regularly abused buprenorphine.

CLINICAL PICTUREA 49-year-old male was hospitalised for progressive generalised spasms associated with dysarthria and opisthotonus. Tetanus was diagnosed clinically.

TREATMENTSupportive management was instituted in the intensive care unit (ICU). Toxicology samples tested positive for buprenorphine.

OUTCOMEHe recovered rapidly and was transferred out of the ICU after 8 days. Retrospective questioning confirmed parenteral abuse of buprenorphine.

CONCLUSIONThis case highlights an uncommon and potentially lethal complication of parenteral drug abuse.

Buprenorphine ; Disease Progression ; Dysarthria ; Humans ; Male ; Middle Aged ; Singapore ; Substance Abuse, Intravenous ; Substance-Related Disorders ; complications ; Tetanus ; diagnosis ; etiology ; therapy

INTRODUCTIONWe present a retrospective descriptive study of cases admitted to Tan Tock Seng Hospital from March 2005 to October 2005 with complications of Subutex abuse.

CLINICAL PICTUREA total of 8 patients were studied. Of the 8, 7 were male and one was female. Their complications consist of the following: arterial pseudoaneurysm (2), arterial pseudoaneurysm with infective venous thrombus (1), infective venous thrombus (1), venous thrombus (2), end arterial spasms (1) and sympathetic dystrophy (1).

TREATMENTFor the patient who presented with buprenorphine-associated neuropathy, non-operative treatment with analgesics was given. Conservative medical therapy involving deep venous thrombosis treatment was instituted for the patient with deep venous thrombosis. Repair, restorative bypass and embolectomy surgery were performed for patients who had severe embolic/thrombotic complications. One of the patients who received the above surgery required amputation of his lower limb.

OUTCOMEOf the 8 patients, 4 were treated medically, 3 required surgery and 1 required amputation. Their recoveries were uneventful. Of the 8, 1 absconded and was not followed up with.

CONCLUSIONParenteral injection of buprenorphine can cause a wide range of vascular complications from simple vascular irritation to severe infective thrombosis and pseudoaneurysms requiring limb amputations. Non-sterile preparation of an injected substance or non-sterile injection sites and the repeated punctures of major vessels are possible culprits in those who are seen to have acute infection of injection sites.

Abscess ; etiology ; Adult ; Aneurysm, False ; etiology ; Buprenorphine ; Female ; Femoral Artery ; Groin ; Humans ; Male ; Middle Aged ; Substance Abuse, Intravenous ; complications

In recent years increased studies on the relationship between addictive drugs abuse and infectious diseases such as acquired immunodeficiency syndrome (AIDS) have shown that these drugs, including heroin, marijuana and cocaine, not only alter the abusers' neuropsychological and pathophysiological responses, but also impair their immune functions. The possible mechanisms may include the direct effect on immune cells or an indirect method ( e. g., stimulation of the hypothalamus-pituitary-adrenal axis). The correlation between intravenous drug users (IVDUs) and human immunodeficiency virus infections has led to the proposal that the immunomodulation mediated by additive drugs is a major factor contributing to the progression of AIDS in IVDUs. Immunosuppression caused by drug abuse may increase the susceptibility to opportunistic infections, while drug abusers' lifestyles also increase exposure risk to infectious pathogens. In summary, increased infection risks and drug-mediated immunomodulation increase drug abusers' susceptibility to infectious pathogens.
Disease Susceptibility ; Humans ; Immune System ; drug effects ; physiology ; Infection ; etiology ; Narcotics ; adverse effects ; Substance Abuse, Intravenous ; complications

OBJECTIVETo study surgical management for patients with femoral pseudoaneurysm resulting from addictive drug injection.

METHODSClinical data of 34 patients with femoral pseudoaneurysm resulting from addictive drug injection were retrospectively reviewed.

RESULTSThirteen patients underwent bypass graft (end to side) of external iliac artery and superficial femoral artery using expanded polytetrafluoroethylene (ePTFE). Three patients who had an autogenous saphenous vein graft in situs, one of whom was then performed an ePTFE graft when rupture and bleeding occurred at the anastomotic site. Color Doppler image showed patent grafted blood vessels in all the patients after operation. Eighteen patients had their femoral arteries ligated. Limbs of all the 34 patients were saved.

CONCLUSIONSLigating femoral artery is an effective way to treat femoral artery pseudoaneurysm if autogenous saphenous vein graft or artificial vessel graft is not applicable.

Adolescent ; Adult ; Aneurysm, False ; etiology ; surgery ; Female ; Femoral Artery ; injuries ; Humans ; Male ; Substance Abuse, Intravenous ; complications ; Treatment Outcome

Adult ; Buprenorphine ; adverse effects ; Disease Progression ; Humans ; Male ; Narcotics ; adverse effects ; Soft Tissue Infections ; chemically induced ; diagnosis ; etiology ; Substance Abuse, Intravenous ; complications ; Substance-Related Disorders ; complications ; diagnosis ; Vascular Diseases ; chemically induced ; diagnosis ; etiology

OBJECTIVE: To investigate the surgical management of infected pseudoaneurysms of femoral artery caused by narcotics injection. METHODS: The clinical data of 63 cases of infected pseudoaneurysms of femoral artery caused by narcotics injection were reviewed retrospectively. RESULTS: The tumors in 52 cases ruptured. Rupture hemorrhoea first occurred in 45 patients before admission and in 7 during hospitalization. Twenty-six patients suffered from recurrent or multiple hemorrhoea while in hospital. Forty-nine patients received external iliac artery-superficial femoral artery extra-anatomic bypass reconstruction with banded vascular grafts and the other 14 received ligation operations of the external iliac artery or the femoral artery. No one died in the perioperative period. One patient with vascular graft reconstruction developed graft infection during hospitalization and 5 developed graft infection during the follow-up. No ischemic necrosis occurred in the affected limbs after the infected vascular grafts were removed. One patient developed necrosis in the affected limb after the femoral artery was ligated and then above-knee amputation was performed. The others recovered well. Unobstructed blood circulation in the vascular graft was exhibited by color Doppler ultrasonography in 36 cases during the follow-up. CONCLUSION Operation as early as possible is the only way to rescue patients' lives threatened by infected pseudoaneurysms of femoral artery caused by narcotics injection. Thorough debridement and drainage, revascularization between external iliac artery and superficial femoral artery using band artificial blood vessel, and controlling infection are therapeutic modus operandi. Ligation of external iliac artery or femoral artery is also a feasible measure to rescue patients' lives when pseudoaneurysms are infected severely.
Adolescent ; Adult ; Aneurysm, False ; etiology ; surgery ; Aneurysm, Infected ; etiology ; surgery ; Female ; Femoral Artery ; surgery ; Humans ; Ligation ; Male ; Middle Aged ; Narcotics ; adverse effects ; Retrospective Studies ; Substance Abuse, Intravenous ; complications ; Vascular Grafting ; Young Adult

OBJECTIVETo investigate the role of revascularization procedures with autologous greater saphenous vein in surgical management of iliac-femoral artery pseudoaneurysm in parenteral drug abusers.

METHODSTwenty-one patients with iliac-femoral artery pseudoaneurysm caused by parenteral drug abuse from 2004 to 2007 were enrolled. Among them, 15 patients were male and 6 were female; their average age was 31.3 years. The size of pseudoaneurysms ranged from 3.0 cm to 7.5 cm. Common femoral artery and distal external iliac artery were often involved. We performed arterial reconstruction on these patients with autologous greater saphenous vein as a graft after excising iliac-femoral artery pseudoaneurysm through a single curved inguinal incision. All patients were followed up, and the complications were recorded.

RESULTSThe surgical procedures were finished without intraoperative mortality or perioperative complications. All patients were free of claudication symptoms after the surgery except one case with preoperative popliteal artery stenosis. One case of infection and wound tissue fistula was found later. One case had inguinal incisional hematoma and another complained of numbness in thigh skin.

CONCLUSIONSThe use of autologous greater saphenous venous grafts for arterial reconstruction after pseudoaneurysm excision in drug abusers is safe and effective. This technique offers more advantages than arterial ligation alone without revascularization. An optimal greater saphenous venous graft is a prerequisite for revascularization.

Adult ; Aneurysm, False ; etiology ; surgery ; Female ; Femoral Artery ; pathology ; surgery ; Humans ; Iliac Artery ; pathology ; surgery ; Male ; Middle Aged ; Neovascularization, Physiologic ; Saphenous Vein ; surgery ; Substance Abuse, Intravenous ; complications ; Vascular Surgical Procedures ; methods ; Young Adult