Cocaine-associated chest pain

Current estimates establish that more than 30 million people in the United States use cocaine. Cardiovascular complaints commonly occur among patients who present to emergency departments(EDs) after cocaine use, with chest pain the most common complaint in several studies. Although myocardial ischemia and infarction account for only a small percentage of cocaine-associated chest-pain, physicians must understand the pathophysiology of cocaine and appropriate diagnostic and treatment strategies to best manage these patients and minimize adverse outcomes. This article reviews the pharmacology of cocaine, its role in the pathogenesis of chest pain with specific emphasis on inducing myocardial ischemia and infarction, and current diagnostic and management strategies for cocaine-associated chest pain encountered in the ED.     

Cocaine-associated dystonic reaction

Dystonic reactions are extrapyramidal motor dysfunctions that result from an insufficient activity of nigrostriatal dopamine and present clinically as spasms of the various muscle groups. Neuroleptic drugs are a known cause of dystonia and are the most frequently encountered trigger. Cocaine use has been associated with dystonias, though much less often. When reported in the setting of a dystonic reaction, cocaine has been described as a predisposing factor for the patient already using neuroleptic agents. Fewer reports of dystonia as a direct result of cocaine use, independent of neuroleptics, are found in the literature. The cases of two acute dystonic reactions secondary to cocaine use are presented, with a discussion of the pathophysiology and treatment alternatives.     

Cocaine-associated chest pain

The pathophysiology of cocaine leading to myocardial ischemia is multifactorial. Given the paucity of well-designed clinical studies, treatment is directed toward the potential mechanisms involved in the development of myocardial ischemia. Fortunately, morbidity and mortality in this patient population are low, and the vast majority of patients will not suffer AMI or other cardiac complications. Long-term prognosis is excellent for those who abstain from continued cocaine use.     

缺血性肠炎病理分析

缺血性肠炎（ＩＣ）是由于多种原因引起肠血循环障碍所致的一种肠疾患，本文报导了１０例ＩＣ的临床特征及诊断。ＩＣ的病理改变为非特异性的，包括不同程度炎反应，肠壁结构破坏，出血和含铁血黄素细胞浸润等。本文学就ＩＣ的分类，与克隆氏病及溃疡性结肠炎的鉴别及病因学进行了探讨。     

缺血性结肠炎的超声图像表现

目的探讨缺血性结肠炎的超声图像特点以及超声诊断价值。方法使用3.5~5.0MHz腹部探头和7.0~14.0MHz高频超声对12例因急性腹痛、便血患者行二维基波、自然组织谐波和彩色多普勒超声检查,分析结肠肠壁增厚的部位、范围、壁厚和彩色多普勒血流等声像图特征。结果全部病例经结肠镜或临床治疗监测、随访证实,超声定位符合率100%(12/12),其中病变累及右半结肠1例(8.4%),左半结肠7例(58.4%),横结肠2例(16.6%),脾曲2例(16.6%)。增厚结肠壁的长度范围10.0~20.0cm(平均15.0cm),壁厚0.5~2.0cm(平均1.3cm),病变呈均匀、全周性增厚。CDFI全部病例肠系膜上动静脉内未见血栓,4例(33.3%)增厚结肠壁间有少量彩色血流信号,8例(66.7%)未见彩色血流信号。结论超声对病变的分布、范围、肠壁厚度、彩色血流等做出正确的判断,超声对缺血性结肠炎的诊断和随访、监测对临床有重要帮助。     

Investigation and management of ischemic colitis

The colon is the most common site of gastrointestinal ischemia. The condition resolves completely with conservative treatment in most cases, but late diagnosis or severe ischemia can be associated with high rates of complications and death. Once ischemic colitis is diagnosed, serial physical examinations and colonoscopies are helpful to follow the condition. Prompt surgery is required for severe episodes, when conservative measures fail, and for patients with chronic symptoms.     

Sonographic findings in methamphetamine-induced ischemic colitis

Ischemic colitis is a clinicopathologic condition that commonly occurs in elderly patients with atherosclerotic disease or diabetes mellitus. Uncommon etiologies include vasculitis and use of drugs such as oral contraceptives, phenobarbital, nasal decongestants, dextroamphetamine, and cocaine. Recent studies have shown sonography and CT to be helpful in the evaluation of the colitides. We report the sonographic and CT findings in an unusual case of methamphetamine-induced ischemic colitis. Sonography and CT revealed diffuse thickening of the large bowel wall. Methamphetamine abuse should be considered in the differential diagnosis of the colitides, particularly in the setting of a young patient with a history of drug use and no other predisposing conditions. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:479–482, 1998.     

Myxedema ascites complicated by ischemic colitis

Myxedema Ascites is a rare finding of primary hypothyroidism, thereby leading to delayed diagnosis. However, prompt treatment with levothyroxine leads to complete resolution of the condition. We present a rare case of myxedema ascites in an elderly female and highlight the importance of early diagnosis and management. We also present ischemic colitis in the same patient, which has not been reported thus far in literature as a complication of myxedema ascites.     

缺血性结肠炎的临床及内镜研究

目的总结缺血性结肠炎的临床表现及内镜特征。方法对该院2000年以来经结肠镜确诊的43例缺血性结肠炎患者的临床及内镜资料进行回顾性总结分析。结果该病50岁以上中老年人易患(38/4388.1%),多数患者伴有高血压、心血管疾病、脑梗死和便秘等基础疾病或诱因。临床主要表现为突发左下腹部痛、便血、腹泻三联征。病变部位主要发生在左侧结肠,内镜下主要表现为病变肠段黏膜充血、水肿、糜烂、溃疡及增生性改变且与正常肠黏膜界限分明。结论中老年人出现急性腹痛及血便时应警惕缺血性结肠炎的可能,及早行结肠镜检查对明确诊断、早期治疗、判断预后具有重要意义。     

缺血性结肠炎的临床及内镜特点分析

目的总结缺血性结肠炎的临床特点和内镜表现,为缺血性结肠炎的诊断和治疗提供依据。方法回顾性分析29例缺血性结肠炎的病例资料。结果本组29例缺血性结肠炎平均年龄59.6岁,60岁以上者17例（58.6%）;23例患者（79.3%）至少合并一种或一种以上基础疾病;临床表现：24例（85.8%）出现阵发性剧烈腹痛,21例（72.4%）有便血症状。内镜下病变肠管呈节段性分布,与正常肠管界限清楚,病变肠管黏膜表现为不同程度充血、水肿,血管纹理不能分辨,散在糜烂和大小形态不同的溃疡,左半结肠多见。26例（89.7%）痊愈,3例（10.3%）好转。结论内镜医师应掌握缺血性结肠炎临床表现及内镜特点,对伴有动脉硬化等基础病变的老年人,若出现腹痛、血便,早期行肠镜检查。缺血性结肠炎及时诊断和治疗,预后一般良好。     

内镜检查对缺血性结肠炎的诊断价值

目的 探讨缺血性结肠炎的内镜特征表现及内镜检查对其诊断价值.方法 对39例缺血性结肠炎患者的临床特点及内镜检查资料进行回顾性分析.结果 缺血性结肠炎好发于老年人,多伴有相关基础疾病.内镜检查提示病变好发于左半结肠,呈节段性分布,结肠粘膜高度水肿、充血、糜烂坏死及溃疡.大多数病例呈一过性表现.结论 老年患者出现急性腹痛、便血时应警惕缺血性结肠炎可能,及时内镜检查对其明确诊断具有重要价值.     

Cocaine-associated rhabdomyolysis and acute renal failure

We have described four male patients, aged 21 to 39 years, who had rhabdomyolysis and acute renal failure during parenteral cocaine use. This complication has only recently been attributed to cocaine. Their illnesses behaved clinically like nonoliguric acute tubular necrosis, though renal biopsies were not done. No permanent nerve, muscle, or kidney damage resulted.     

Cocaine-associated dissection of the thoracic aorta

Patients present to emergency departments with a variety of complications related to cocaine abuse. Emergency physicians must be aware of the life- and limb-threatening complications to avoid undue mortality and morbidity. We present the case of a patient with aortic dissection who developed the acute onset of abdominal pain 5 minutes after subcutaneous cocaine use. Four previous reports of cocaine-associated aortic dissection are reported in the literature. These cases and other reports of intra-abdominal vascular injuries related to cocaine use are reviewed. Cocaine's mechanism of action as it relates to aortic dissection and some of the pharmacologic agents available for treatment are discussed.     

Cocaine-associated Chest Pain: One-year Follow-up

Objective: To determine the one-year mortality and incidence of myocardial infarction (MI) post-hospital discharge or ED release for patients with cocaine-associated chest pain.
Methods: A prospective, observational study of an inception cohort of consecutive patients who presented to one of four municipal hospital EDs with cocaine-associated chest pain. Patients were followed for one year from the end of the enrollment period. Main outcome parameters were the one-year actuarial survival and the frequency of nonfatal MI.
Results: Mortality data were available for all 203 patients at a mean of 408 days. Additional clinical information was available for 185 patients (91%). There were six deaths (one-year actuarial survival 98%; 95% CI, 95–100%); none from MI. Nonfatal MI occurred in two patients (1%; 95% CI, 0–2%). Continued cocaine use was common (60%; 95% CI, 52–68%) and was associated with recurrent chest pain (75% vs 31%, p < 0.0001). No MI or death was reported for patients who claimed to have ceased cocaine use.
Conclusions: Patients who presented with cocaine-associated chest pain commonly continued to use cocaine after discharge. Urgent evaluation of coronary anatomy or cardiac stress tests may not be necessary for patients for whom MI is ruled out and who do not have recurrent potentially ischemic pain. The subsequent risk for MI and death in this group appears to be low. Intervention strategies should emphasize cessation of cocaine use.     

缺血性结肠炎63例临床分析

目的 总结缺血性结肠炎(ischemic colitis,IC)患者的临床特征、内镜表现、诊断及治疗方法.方法 对63例患者的临床症状、易患因素、体征、结肠镜检查资料进行回顾性分析.结果 IC好发于50岁以上中老年人,占87.3%(55/63);主要临床表现为急性下腹痛以及便血;易患因素提示病变主要发生在高血压、冠心病、糖尿病等人群;内镜分型均为非坏疽性,未发现坏疽性缺血性结肠炎;内镜下病变肠段与正常肠段分界较明显,表现为黏膜充血、水肿,黏膜下红斑,点状糜烂及浅溃疡,多呈纵行或不规则形.2周后59例复查结肠镜患者病变54例(91.5%)痊愈;5例(5/59,8.5%)患者病变明显减轻,有黏膜红斑,轻度充血、水肿;2例(3.1%)出现肠腔局部狭窄4例肠镜后缺血性结肠炎患者症状缓解,未复查肠镜;无死亡病例.结论 中老年患者出现急性下腹痛和便血时应警惕IC的可能,及早内镜检查是明确诊断、了解病变范围及程度、判断预后的主要手段.     

高压氧治疗缺血性结肠炎的疗效观察

目的：观察探讨高压氧治疗缺血性结肠炎的疗效。方法：入选67例缺血性结肠炎患者,将患者分为高压氧组（36例）和对照组（31例）,2组基础治疗相同。高压氧组在此基础上人院次日行高压氧治疗,比较研究两组患者结肠恢复的治愈率及总体有效率。结果：高压氧组和对照组总有效率分别为91．7％和67．7％,两组总有效率比较差异有统计学意义（P〈O．05）。结论：高压氧治疗缺血性结肠炎具有显著疗效。     

缺血性结肠炎90例临床诊治分析

目的 探讨缺血性结肠炎(Ischemic colitis,IC)的临床诊断及治疗,进一步提高对该病的认识.方法 回顾性分析1995年6月至2009年5月90例Ic患者的临床资料.结果 90例患者中,72例患有血管相关性疾病,18例无可以证明的基础病变;临床主要表现均为腹痛,部位以脐周及左下腹为最多84例(93.33%);病变发生在乙状结肠35例(38.9%),降结肠20例(22.2%),降乙交界处25例(27.8%).结论 缺血性结肠病多数病因为肠血流阻塞性病变,急性发作的腹痛是其临床特点,内镜检查是诊断本病的有效方法.