Avascular necrosis of the femoral head due to the bilateral injection of heroin into the femoral vein: A case report

Wu, Dengke; Song, Deye; Ni, Jiangdong; Dai, Renke

doi:10.3892/etm.2013.1236

Cited by 8 publications

(4 citation statements)

References 16 publications

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“…It is complicated that how heroin occurs osteonecrosis of femoral head [12] , [13] , [14] . Wu et al show osteonecrosis of femoral head in the patient who injected heroin to femoral vein [7] . They explain process with thrombophlebitis resulting from the intravenous injection.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral avascular necrosis of the femoral head due to the use of heroin: A case report

Özkunt

Sariyilmaz

Sungur

et al. 2015

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

“…Avascular necrosis of the femoral head (ANFH) due to heroin use is a rare condition. There are few reports of heroin injection to the femoral veins resulted with thomboflebitis and subsequently ANFH [7] . However, osteonecrosis of femoral head caused by heroin without injection to the femoral veins is not reported.…”

Section: Introductionmentioning

confidence: 99%

Bilateral avascular necrosis of the femoral head due to the use of heroin: A case report

Özkunt

Sariyilmaz

Sungur

et al. 2015

International Journal of Surgery Case Reports

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“…Temgesic vials contain corticosteroids and almost all abusers have signs of hypercortisolism, such as striae on their abdominal skin (4). Biochemical studies revealed that the available product in Iran consists of diacetylmorphine, acetylcodeine, pheniramine and heroin (4,5,15). As each vial contains 0.4mg Dexamethasone (4), patients of the present study had received an average of 767 mg (ranged 299 to 1792) Dexamethasone by the time of pain onset, which is equivalent to 5061 mg (ranged 1973 to 11827) of prednisone (16).…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With the Course of Femoral Head Osteonecrosis; A Retrospective Study

Abolghasemian¹,

Shirazi²,

Gharanizadeh³

et al. 2015

Shafa Ortho J

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Background: An increased incidence of osteonecrosis of the femoral head (ONFH) has recently been observed in Iran, likely associated with the introduction of an illegal, steroid-containing opioid drug, Temgesic. The correlation of risk factors associated with the course of ONFH has yet to be determined. Objectives: The purpose of the present study was to assess the effects of etiologic factors on the course of ONFH after emergence of symptoms. Patients and Methods:We retrospectively assessed patients with untreated ONFH due to one of the four etiologies of steroid medication, Temgesic abuse, trauma and idiopathic. Patients with multiple risk factors and those without collapse at the last follow-up visit were excluded. The effect of age, gender, etiology of osteonecrosis, opium addiction and smoking on the time interval between pain onset and radiologic collapse were investigated. Results: In total, 110 patients (174 hips) were categorized into four etiologic groups. The average time between onset of pain to radiologic collapse in different etiologic groups was 12.8 months for all groups, 12.4 months for steroid, 8.7 months for Temgesic, 18.5 months for trauma and 16.6 months for idiopathic groups. Thirteen hips had collapse in less than six months. Patients who used steroid and Temgesic had shorter time interval to collapse, which was statistically significant (P Values < 0.001 and < 0.001, respectively). Smoking had a statistically significant association with the time to femoral head collapse (P Value = 0.003). Conclusions: Steroid medications and Temgesic abuse are associated with shorter time interval to femoral head collapse. Smoking is also a factor associated with shorter time interval to collapse. These factors should be considered in any joint preserving treatments for patients with FHON.

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“…Osteoblasts Previous studies have demonstrated that the number of cases of ANFH that occur following the use of steroids is increasing (47)(48)(49). Without therapy or intervention, femoral head necrosis may become an irreversible process (50,51).…”

Section: Tissuesmentioning

confidence: 99%

11β‑hydroxysteroid dehydrogenases as targets in the treatment of steroid‑associated femoral head necrosis using antler extract

Peng

2017

Exp Ther Med

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Abstract. The aim of the present study was to investigate the therapeutic effect of deer antler extract on avascular necrosis of the femoral head (ANFH) induced by steroids, and to confirm that 11β-hydroxysteroid dehydrogenases (11β-HSD) are one of the targets of treatment with antler extract. A total of 30 rabbits were randomly divided into 5 groups (n=6): A control, ANFH, ANFH + antler (250 mg/kg), ANFH + antler (500 mg/kg) and ANFH + antler (1,000 mg/kg) group. Rabbits in the experimental groups were injected with methylprednisolone and horse serum to establish a steroid-induced ANFH (SANFH) model. Rabbits in the ANFH + antler (250 mg/kg), ANFH + antler (500 mg/kg) and ANFH + antler (1,000 mg/kg) groups were treated with intraperitoneal injection of 250, 500 or 1,000 mg/kg antler extract/day, respectively, for 60 days. Serum samples were then extracted to determine total cholesterol (CT) and triglyceride levels, treat osteoblasts, measure 11β-HSD (11β-HSD1) and 11β-HSD2 and alkaline phosphatase (ALP) levels and cellular apoptosis, and determine the proportion of osteoblasts in each phase of the cell cycle. Serum CT and triglyceride levels in SANFH rabbits significantly decreased as the concentration of antler increased (P<0.05). 11β-HSD1 levels in the femoral heads of SANFH rabbits and osteoblasts following treatment with antler-containing serum decreased as the concentration of antler used increased, whereas levels of 11β-HSD1 increased significantly (P<0.05). The proliferation of osteoblasts and ALP levels in osteoblasts increased as the antler concentration increased, whereas the number of osteoblasts in the G0/G1 phase decreased significantly (P<0.05). The current study demonstrated that treatment with antler extract has a therapeutic effect on ANFH induced by steroids in rabbits and may regulate the expression of 11β-HSD in femoral heads and osteoblasts, as well as promoting the proliferation of osteoblasts. IntroductionOsteonecrosis of the femoral head (ONFH) is caused by the interruption of the blood supply to the femoral head or the pathological process of osteoblast death (1,2). Steroid-induced avascular necrosis of the femoral head (SANFH) is a type of non-traumatic ANFH and the most common type of femoral head necrosis. It occurs following the long-term use of adrenocorticotropic hormones (ACTH) or the use of high doses of ACTHs (3-5). The major clinical characteristics of ANFH include hip pain, limited mobility, lameness and a high disability rate, which negatively impact patient health and quality of life (6-8). It is estimated that ~50% of all ONFH cases are induced by ACTH (5,9,10). In China, there are 5-7.5 million patients with ONFH requiring treatment and the number of new ONFH cases was 150,000-200,000 in 1998, with the majority of cases diagnosed in young adults (11).Corticosteroids are widely used to treat several diseases, including asthma (12), nephritic syndrome (13) and leukemia (14), as they suppress inflammation, allergic reactions and the immune response. However, in the process of...

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Avascular necrosis of the femoral head due to the bilateral injection of heroin into the femoral vein: A case report

Cited by 8 publications

References 16 publications

Bilateral avascular necrosis of the femoral head due to the use of heroin: A case report

Bilateral avascular necrosis of the femoral head due to the use of heroin: A case report

Factors Associated With the Course of Femoral Head Osteonecrosis; A Retrospective Study

11β‑hydroxysteroid dehydrogenases as targets in the treatment of steroid‑associated femoral head necrosis using antler extract

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