Transcript Document

ORAL PRESENTATION
I National Congress on Clinical Toxicology, Sofia,October
23-25, 2003
ILIOFEMORAL VENOUS THROMBOSIS
AMONG INJECTING USERS IN SKOPJE
B.Pavlovski, C.Bozinovska, A.Cibisev,
D.Petrovski, N.Popovski, F.Licoska, V.Jordanov
Clinic for Toxicology and urgent Internal
medicine. Clinical Centre. Skopje. R.Macedonia
BACKGROUND 1.
 GENERAL VIEW
 NARCOTICS ARE COMING IN ALL
TRANSITION COUNTRIES
 MARIJUANA
 SYNTHETIC NARCOTICS-ECSTASY
 HEROIN
 COMMON PROBLEM- COMMON INTEREST
BACKGROUND 2.
MAIN CARACTERISTICS OF ADDICTS IN
SKOPJE REGION
1. ADDICTS START WITH MARIJUANA
2. FASTLY CROSSING ON HEROIN ABUSE
3. STARTING WITH HEROIN
4. YOUNG PEOPLE. THE MEAN AGE 21 YEAR
HEROIN ADDICTS IN OUR DAILY
TOXICOLOGICAL PRACTICE:
1.HEROIN OVER DOSES
2.CRISIS OF ABSTINENCE
3.FOR DETOXIFICATION-PROGRAMME
FOR CESSATION
4.VASCULAR COMPLICATIONS
 DURING RECENT FOUR YEARS 22
PATIENTS, CURRENT INTRAVENOUS HEROIN
ADDICTS WITH SEVERE DAMAGE TO THE
GROIN VESSELS WERE TREATED IN OUR
CLINIC. ALL OF THE PATIENTS WERE
CHRONIC INJECTING DRUG USERS WITH
MEDIAN INJECTION DURATION OVER FOUR
YEARS
ANALYTICAL APPROACH ON DIFFERENT WAY OF
INJECTION:
1. IN THE BEGINNING, THE MOST USED REGION
OF INJECTING HEROIN IS REGION OF VEIN
MEDIANA CUBITI, BASILICA, CEPHALICA
2. VENNE MANUS – RETE VENOSUM PALMARE
3. GROIN VESSELS: VEIN FEMORALIS, VEIN
SAPHENA MAGNA
4. VEIN POPLITEA, VEIN SAPHENA PARVA
5. RETE VENOSUM DORSALIS PEDIS, RETE
VENOSUM CALCANEI
THE PLACE OF VESSELS DAMAGE
4 patients
Bilateral damage of
wein femoralis
12 patients Unilateral injury of
wein femoralis - left
5 patients
Unilateral injury of
wein femoralis-right
1 patient
Damage of wein
poplitea - left
 INJECTING HEROIN IN REGION IN GROIN VESSELS
CLEARLY SHOWED – LONG TERM ABUSE OF
HEROIN AND DESTRUCTED VEIN SYSTEM.
 YOUNG PEOPLE - OLD ADDICTS
THE AIM OF THIS STUDY: TO EVALUATE
THERAPEUTIC APPROACH IN THIS GROUP
OF PATIENTS
MATERIAL AND METHODS:
 22 PATIENTS, ACTIVE HEROIN USERS
WITH THROMBOPHLEBITIS WERE
OBSERVED IN LAST FOUR YEARS.
 CLINICAL PICTURE:
DOMINANT SIGNS AND SYMPTOMS
WERE: HARDLY WALK, SWELLING
FOOT, ULCERS, TEMPERATURE AND
PAIN IN THE INFERIOR EXTREMITIES.
NUMBER OF PATIENTS, SEX, AGE AND TIME OF ABUSE
STATISTICAL ANALYSIS
Patients
22
Male
16
Female
6
Age
25
Time of
abuse:
over 4
years
AT EVERY PATIENT WERE MADE:
1. ROUTINE LABORATORY-BLOOD AND URINE
TESTS
1. TOXICOLOGICAL ANALYSIS-TO GIVE
PROOF-HEROIN,METHADON,BZ
2. MARKERS OF HEPATITIS A,B,C
3. DOPPLER – ECHO ULTRASOUND-PLACE OF
VEIN OCLUSION
TREATMENT:
 ALL PATIENTS WERE TREATED WITH
SUBCUTANEOUS LMWH – LOW –
MOLECULAR – WEIGHT HEPARIN
(FRAHEPAN, 2x3000 IU FOR 4 WEEKS),
 ANTIBIOTICS-PENICILLIN, AND
CIPROFLOXACIN AND METRONIDAZOL
 LOCAR CARE - WITH COMPRESS OF ACIIDI
BORICI AND UNQ-HEPATHROMBIN
FRAHEPAN (CERTOPARINUM NATRICUM)
RESULTS:
 ALL PATIENTS TESTED FOR HEPATITIS C
VIRUS WERE SEROPOSITIVE.
 SATISFACTORY CLINICAL RESPONSE –
 12 PATIENTS,
 6 PATIENTS HAD PERSISTENTLY
SWOLLEN LEG
 4 WERE LOST TO FOLLOW UP
 ONE DRAINAGE OF ABSCESS IN REGION
OF VEIN POPLITEA WERE CARRIED OUT
CONCLUSION:
 FOR SATISFACTORY CLINICAL RESPONSE
WE PREFERE TO CONTINUE WITH
ANTICOAGULANT WITH FRAHEPAN
THERAPY FOR AT LEAST THREE MONTHS.
 METHADONE AS SUPPORTING
TREATMENT SHOULD BE GIVEN IN
SELECTED PATIENTS.
 IT IS VERY DIFFICULT TO FOLLOW
ADDICTS, THEY RARELY COME AT
REGULAR CONTROL INVESTIGATION