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The incidence of smuggling and transporting illegal substances by internal concealment, also known as body packing, is on the rise. The clinical approach to such patients has been changed significantly over the past 2 decades. However, despite a recorded increase in body packing in general, there are controversies in the management of these patients. We aimed to gather data regarding the demographic characteristics, treatment, and outcome of body packers, which were that referred to Loghman Hakim Hospital, Tehran, Iran.The data of all body packers admitted to Loghman Hakim Hospital during 2010 to 2014 were evaluated retrospectively. Data regarding the demographic characteristics of the patients, findings of clinical imaging, treatment, and outcome were recorded.In this study, 175 individuals with a mean age of 31 ± 10 years were assessed. The most common concealed substances were crack (37%), crystal (17%), opium (13%), and heroin (6%). According to the results of surgery and imaging (abdominal radiography or computed tomography), the most common place for concealment was stomach in 33.3% and 12% of cases, respectively. Imaging findings were normal in 18% of the individuals. Forty-eight (27%) patients underwent surgery. The main indications for surgery were clinical manifestations of toxicity (79%) and obstruction of the gastro-intestinal tract (17%). The most common surgical techniques were laparotomy and gastrotomy (50%). The mean duration of hospitalization was 3.8 ± 4 days. The mortality rate was 3%.Conservative treatment of body packers seems to be the best treatment method. Careful monitoring of the patients for possible signs and symptoms of intoxication and gastro-intestinal obstruction is strongly recommended.

Red blood cell (RBC) velocity, capillary hematocrit (Hctcap), RBC flux, and arteriolar diameter were studied in the subcutaneous connective tissue of the Syrian hamster skinfold window preparation during successive normovolemic hemodilutions with 6% solutions of Dextran 70. The experiments were carried out in the unanesthetized animal. Heart rate (HR), mean systemic arterial pressure (Psys), and systemic hematocrit (Hctsys) were monitored throughout the procedure to ensure that normovolemia was maintained and hemodilution caused no adverse effects. The changes of RBC flux in the hemodiluted state, up to 50% hemodilution (Hctsys = 25% +/- 4), were not statistically significant when compared with control (t test, P less than 0.5). At this Hctsys, capillary RBC velocity increased by 60% and Hctcap decreased by 30%. Both of these changes were statistically significant relative to control. The arteriolar diameter did not change significantly during the reduction of Hctsys. The animals were studied during subsequent days to determine the chronic effects of hemodilution. Hctsys increased by approximately 12% per day after the experiment, and the systemic parameters returned to the prehemodiluted state in direct proportion to the reestablishment of the Hctsys.

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The effect of acute normovolaemic haemodilution on microvascular red blood cell flow was studied by intravital microscopy in the tenuissimus muscle of the rabbit. Blood was substituted isovolaemically with equal volumes of a 6% solution of dextran 70 (MW 70,000). The systemic haematocrit (Hsys) decreased from 36 +/- 4% (mean +/- SD) to 17 +/- 2%. Following haemodilution capillary haematocrit (Hcap), as measured by video densitometric methods, decreased by 20 +/- 9%. The reduction of Hcap was significantly smaller than that of Hsys, and Hcap normalized with respect to Hsys increased from 0.39 +/- 0.07 in the control situation to 0.62 +/- 0.18 after haemodilution. Red blood cell velocity (vrbc) increased by 45 +/- 20% and compensated for the decrease in Hcap in such a way that the red blood cell flux, calculated from vrbc and Hcap, remained unchanged. Measurements of volume flow in the feeding arterioles in the muscle revealed a fractional redistribution of blood flow in favour of the muscle capillaries following haemodilution at the expense of vessels in adjacent connective tissue supplied by the same arterioles. This fractional flow redistribution was likely the basis for the relative increase in capillary haematocrit seen after haemodilution. The present data demonstrate that an acute reduction of the systemic haematocrit is compensated for in an active regulating vascular bed by a proportionally smaller decrease in capillary haematocrit and by an increased capillary red cell velocity. Microvascular haematocrit was found not to be a constant fraction of the systemic value, which supports the view of capillary haematocrit as a 'controlled' physiological variable.

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