Asunto(s)
Endocarditis Bacteriana/diagnóstico , Abuso de Sustancias por Vía Intravenosa/microbiología , Veillonella/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Ceftriaxona/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Enfermedades de las Válvulas Cardíacas/tratamiento farmacológico , Enfermedades de las Válvulas Cardíacas/microbiología , Humanos , Masculino , Metronidazol/uso terapéutico , Factores de RiesgoRESUMEN
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Asunto(s)
Femenino , Persona de Mediana Edad , Humanos , Enteritis/etiología , Nutrición Parenteral en el Domicilio , Radioterapia/efectos adversos , Traumatismos por Radiación/terapia , Enteritis/terapia , Neoplasias Uterinas/radioterapiaAsunto(s)
Hiperhomocisteinemia , Metilenotetrahidrofolato Reductasa (NADPH2)/genética , Mutación Puntual/genética , Trombosis , Adulto , Humanos , Hiperhomocisteinemia/sangre , Hiperhomocisteinemia/complicaciones , Hiperhomocisteinemia/enzimología , Masculino , Trombosis/sangre , Trombosis/complicaciones , Trombosis/enzimologíaRESUMEN
Disease secondary to heroin abuse constitutes a rarity in Spain. While there had been no previous cases in earlier years four young heroin addicts were admitted to the Hospital "1st de Octubre" for severe medical complications of their addiction within the last twelve months. Two patients were admitted in deep coma due to drug overdose, being cardiac arrhythmias and pulmonary edema the main associated complications. Cardiac rhythm disturbances are due to a heightened vagal tone, either secondary to inhibition of acetylcholine hydrolysis or to hypoxia, hypercapnia, and acidosis, factors that diminish cholinesterase activity and act synergistically to increase vagal tone. Pulmonary edema secondary to heroin overdose is non-cardiogenic and probably due to hypoxia added to the local action of heroin on the alveolocapillary membrane. The goal of therapy in such cases is to obtain an appropriate alveolar ventilation, the use of continuous positive pressure ventilation being required when there is pulmonary edema. The third patient had staphylococcal pneumonia with multiple abscess formation secondary to venous septic embolization originated peripherally where the drug was injected. Finally, the fourth patient was admitted because of a clinical and biochemical picture of HBsAg negative acute viral hepatitis, having suffered a similar clinical picture three years previously.