A 36-year-old drug addict presented to the emergency room after intravenously injecting 20 milliliters of pure gasoline. At the initial evaluation, he had complained of severe "freezing" chest pain and raging thirst. He provided a remote history of intravenously injecting low doses of gasoline. The admission examination was notable for a pronounced scent of gasoline on his breath, hypotension, and respiratory distress with diffuse rhonchi throughout the lungs. The laboratory workup showed severe metabolic acidosis, leukocytosis with neutrophilia, and markedly elevated serum myoglobin. The patient was treated with corticosteroids and maximum supportive care but there was no improvement. A chest radiograph was not performed given the patient's rapid decline. He soon developed large-volume hemoptysis and died without a definitive diagnosis 4 hours after presentation to the hospital. Postmortem examination was significant for diffusely enlarged and blood-filled lungs (Figure 1A, B). The left lung weighed 1780 g and the right lung weighed 1890 g (a normal lung weighs ~ 300-400 g). Microscopically, all lung sections demonstrated diffuse areas of fresh hemorrhage (Figure 1C). Thickened alveolar septa contained many neutrophils with dilated capillaries consistent with capillaritis (Figure 1D). There were also prominent hemosiderin-filled alveolar macrophages that showed evidence of previous alveolar hemorrhage (Figure 1E). Targeted toxicology confirmed a high concentration of hydrocarbons in the postmortem blood.
A broad spectrum of conditions including neuropathic pain, complex regional pain syndrome (CRPS) and fibromyalgia, have been implicated as causes of chronic pain. There is a need for new and effective treatments that patients can tolerate without significant adverse effects. One potential intervention is hyperbaric oxygen treatment (HBOT). The case reported here is unique in describing repeated HBOT in a patient who developed recurrent post-traumatic CRPS of the lower as well as the upper limbs. In the first event, two months after distortion and abruption of the external right ankle, the patient suffered leg pain, oedema formation, mild hyperaemia, limited mobility of the ankle and CRPS Type 1. In the second event, the same patient suffered fracture-dislocation of the distal radius 1.5 years after the first injury. After the plaster cast was removed the patient developed pain, warmth, colour changes, oedema formation and limited wrist mobility with CRPS Type 1. Pharmacological treatment as well as HBOT were used with significant improvement of functional outcome in both cases. Some studies suggest that patients with a history of CRPS are more likely to develop secondary CRPS compared to the rates reported in the literature among the general population. Patients with a history of CRPS should be counselled that they may be at risk for developing secondary CRPS if they undergo surgery or sustain trauma to another extremity.
3,4-methylenedioxymetamphetamine (MDMA), also known as “ecstasy”, “tulips”, or “Molly”, is an increasingly used “recreational drug” particularly among teenagers and young adults along with the widespread conviction that MDMA is a “safe drug”. The reason for this substance being abused is a desire for closeness to other people, develop a greater tolerance of their views and feelings, and even to touch them physically. According to these effects MDMA is classified also as an “empatogenic” or “entactogenic”. Although MDMA is used for the above-mentioned socially acceptable purposes, in many individuals the drug usage is followed with side-effects varying from mild to severe, potentially even life-threatening. One of the most significant complication of MDMA intoxication is hyper-thermia in the consumer. Authors presented a case of MDMA toxicity with severe hyperthermia (42 ºC) with a fatal outcome to the ecstasy-influenced subject. The aim of this article is to describe the effects of ecstasy, the “recreational drug” widely used in local pubs, dance clubs, and during open air festivals, even in the Slovak Republic.
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