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Harm Reduction ⫸CASE STUDIES - It could happen to YOU!⫷

I agree. I am never reckless, I always take the time to do it right.

Amen to that, even with the ease of Dilaudid to IV and the relatively small amount of binders in the Malli Dilaudid's I keep a constant supply of .20um Micron filters, and im lucky if I IV them once a month. I just want to make sure if i'm going to be unhealthy, It's as healthy and unhealthy it can be. I only do it when I can't get relief from my chrohn's any other ROA besides going to the ER for a $3,000 visit to get a Dilaudid shot and some Fluids with a little bit of Zofran. All meds I have at home. It sucks to not have insurance right now, so do what you gotta do.

It's your body and you only get one of them. Why be reckless with yourself?
 
Imaging Features of Soft-Tissue Infections and Other Complications in Drug Users After Direct Subcutaneous Injection ("Skin Popping")
Ciaran Johnston and Mary T. Keogan - AJR 2004; 182:1195-1202
http://www.ajronline.org/cgi/content/full/182/5/1195

Abstract
Drug abuse is a serious problem, both globally and at a local level, with more than 13,400 opiate abusers in Dublin, Ireland, alone [1]. Infectious complications are responsible for 60-80% of hospital admissions of IV drug users [2]. In 2000, in the United Kingdom and Ireland, fatalities associated with soft-tissue inflammation and severe systemic sepsis were linked to "skin popping" (injection of drugs into the skin and subcutaneous tissues rather than directly into a vein). Clostridium species were implicated in the pathogenesis [3, 4]. Superficial infection may progress to more widespread local or distant disease. Primary soft-tissue infections in IV drug users include cellulitis, abscess, myositis, pyomyositis, and necrotizing fasciitis. Secondary effects of IV drug use include septic arthritis and tenosynovitis, secondary osteomyelitis, vascular complications, soft-tissue ulceration, and fistula formation. In this review, the range of complications caused by skin popping that may develop will be shown. Early imaging to define disease extent and complications is important because clinical deterioration can be precipitous.



Fig. 1. 22-year-old man with broken IV needle tip in left groin with surrounding abscess formation.
A, Anteroposterior radiograph of pelvis shows radiopaque needle tip.
B, Contrast-enhanced CT scan of pelvis obtained with soft-tissue window setting shows abscess formation (arrow) around needle tip with diffuse enhancement and central low attenuation

Fig. 3. 39-year-old man with superficial skin ulceration and cellulitis of right leg caused by IV drug use.
A, Coronal T1-weighted MR image (TR/TE, 450/13) shows reticular low signal (arrows) in subcutaneous tissues of right thigh and deep skin defect (arrowhead).

Fig. 7. 22-year-old man with muscle affected by pyomyositis progressing to abscess formation.
A, CT scan obtained with soft-tissue window setting shows gross enlargement of left thigh with extensive ulceration (arrowheads) anteromedially
(NOTE; look at the size of the effected leg!!)

Fig. 10. Digital subtraction angiogram of right superficial and deep femoral arteries in 38-year-old woman shows pseudoaneurysm (arrow) arising from superficial femoral artery associated with repeated "groin hits"

Thanks to TChort
 

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It hurts like a son of a bitch to subcutaneously inject a drug, how can people do that to themselves willingly?
 
^ Actually oil shots don't hurt. Water based shots hurt less when the liquid isn't squirted in all at once (ie 1mL injected over 10s).
I think we both know when SC happens with rec drugs though; 1) the shot is congealing from blood from a partial shot, 2) no veins left
 
or just plain being sick and not realising (read : caring) what you're actually doing.

another good read:)
 
Thought this might be of some interest ...

Abstract: Medical examiners often receive cases with limited medical history. Sometimes the medical history received is slightly skewed, or even incorrect. Here we describe a case which was initially referred to the Bexar County Medical Examiner's Office from a large community hospital as a case of zolpidem overdose. The deceased presented to the hospital with hypertension, elevated temperature, worsening bizarre behavior, and movement irregularities. While in the hospital, the decedent developed seizure-like activity and died approximately 15 hours after admission. A complete autopsy was performed and yielded no significant gross or histologic abnormalities. A full toxicologic analysis revealed therapeutic levels of citalopram and phenytoin. Zolpidem was not present. Further review of the decedent's medical history as well as information provided by the next of kin revealed that the deceased had been taking diazepam for several years but had recently been switched to alprazolam. The decedent had abruptly stopped taking the alprazolam approximately 4 days before admission when she ran out of the medication, after taking approximately 200 mg in a 6-day period. Given the inconsistent clinical presentation and the findings at autopsy, we suspect that she suffered from benzodiazepine withdrawal and not an overdose as initially reported. Although it is possible that the zolpidem, reportedly taken in the 12 hours before admission, masked the initial symptoms of withdrawal, the constellation of symptoms and signs at presentation are more consistent with benzodiazepine withdrawal than of zolpidem overdose. In this report, we emphasize to the forensic community that one must maintain a high index of suspicion for alternative explanations if the initial report does not seem to fit the presentation or autopsy findings. This case illustrates that although it may take some extra time and effort, further investigation into clinical history can prove crucial to obtaining the correct cause of death and manner of death. This is only the second case within the English literature of death because of benzodiazepine withdrawal.

http://journals.lww.com/amjforensic...tal_Case_of_Benzodiazepine_Withdrawal.14.aspx
 
fuck. i never want to even touch a needle after seeing this thread.

with my luck something bad would happen to me. f that

Then I am very greatful for this thread. I don't want to see my worst enemy go through the things I did because of IV drug use. With the crap out there now yes something bad could very well happen to you. Once you cross that line of using needles no matter wether it is IM or IV, there is no going back..Been there, done that......

LillyF40
 
Once you cross that line of using needles no matter wether it is IM or IV, there is no going back

Not so convinced about that, myself. Once the genie is out of the bottle you can't put it back, but you can choose when to take your wishes. I served my years of IV use - and have the near complete absence of functioning veins to show for it - but I rarely inject anything these days. The compulsion to inject is ridiculously strong, but the longer you stay away from the endless daily cycle of addictive drugs in combination with using needles the easier it gets.

There's nothing wrong with using drugs intravenously or IM or even SC (ick and ouch 8o) if the drugs are "right" and all is done safely. It's more when you're just injecting random crap anywhere you can get the needle in to try to take the pain away and attempt to peel that monkey off for a coupla hours that things get sloppy and Bad. Everything in moderation - including needles - in my book. Just do it with extreme caution if you are doing it at all :)

Also, great thread, DJ :)
 
Not so much addictioj, but reckless addiction. Addiction is a compulsion to use, but it's always in ones power to eat or plug an mscontin rather than IV or IM(!) it

Right on friend!!!

LillyF40%)
 
^ Actually oil shots don't hurt. Water based shots hurt less when the liquid isn't squirted in all at once (ie 1mL injected over 10s).

Even when I'm having my shot being pushed in as slow as can be, even if I just slip out or poke through (though it is rare when this happens) it hurts like a SOB when it does, and I can instantly tell what's going on, so I typically have it stop before it gets serious, but it still hurts a lot, even when pushing slowly.

I only have around 20 units to begin with, so even if it takes a good four or five seconds to get 20 units in, if I miss even a slight bit I'm in pain.


I think we both know when SC happens with rec drugs though; 1) the shot is congealing from blood from a partial shot, 2) no veins left

I could never SI deliberately. In fact, I think being kicked in the balls would hurt less than a fully missed SI. I'm not even kidding.

If I had no veins left (I have all of them left because I take care of myself) I would quit IVing...but I understand your tragic point about careless IDU's djsim. :(

Not so convinced about that, myself. Once the genie is out of the bottle you can't put it back, but you can choose when to take your wishes. I served my years of IV use - and have the near complete absence of functioning veins to show for it - but I rarely inject anything these days. The compulsion to inject is ridiculously strong, but the longer you stay away from the endless daily cycle of addictive drugs in combination with using needles the easier it gets.

There's nothing wrong with using drugs intravenously or IM or even SC (ick and ouch 8o) if the drugs are "right" and all is done safely. It's more when you're just injecting random crap anywhere you can get the needle in to try to take the pain away and attempt to peel that monkey off for a coupla hours that things get sloppy and Bad. Everything in moderation - including needles - in my book. Just do it with extreme caution if you are doing it at all :)

Also, great thread, DJ :)
I agree with Shambles here.

I only IV'd heroin a handful of times, and found snorting it to be more addictive than shooting it. A fellow BL user has found smoking BTH more addictive than IVing it. IV heroin is highly subjective for a lot of different people. I certainly enjoyed it the few times I did it, but it wasn't something I sought out heavily - I was starting to cut back when I first tried IVing heroin. I soon quit after trying it a few times IV, and am completely OK with it.

I have also used cocaine IV (no desire to repeat), MDA IV (no desire to repeat, but the experience was wonderful), ketamine IV (I'd repeat it, but no strong desire, no craving, I would be fine with snorted ketamine as well, but IV ketamine is something special=D), and I tried 2c-E IM'd twice. I wouldn't reuse a 2c-_, especially IMing it.
 
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Successful lung transplantation for talcosis secondary to intravenous abuse of oral drug
D Shlomi et al 2008; Int J Chron Obstruct Pulmon Dis. 2008 June; 3(2): 327-330.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2629966

Abstract:
Talcosis due to intravenous injection of oral drugs can cause severe pulmonary disease with progressive dyspnea even when drug use is discontinued. We describe a 54-year-old woman with severe emphysema who underwent left lung transplantation. The patient had a remote history of intravenous injection of crushed methylphenidate (Ritalin) tablets.
...
We describe a patient with severe emphysema due to pulmonary talcosis from intravenous methylphenidate abuse who underwent successful lung transplantation. We review the literature.


Case History:
A 54-year-old woman employed as a physiotherapist presented to our center in August 1999 with complaints of dyspnea. The diagnosis was emphysema. The patient had a history of heavy smoking (20-40 pack-years) until 1990 and of intravenous methylphenidate abuse for 4 years, 20 years previously. She also had rheumatoid arthritis treated with prednisone 7.5 mg qd and positive serology for hepatitis C, presently not active, with recent undetectable plasma RNA levels. Lung function test showed a forced expiratory volume in one second (FEV1) of 28%, forced vital capacity (FVC) 56%, total lung capacity (TLC) 120%, residual volume (RV) 242%, and diffusing capacity for carbon monoxide (DLCO) 33% of predicted values. Treatment with salbutamol and ipratropium bromide inhalers was started.

Two years later, a significant deterioration was noted in the patient’s functional capacity. She was unable to conduct activities of daily living and became oxygen-dependent. Physical examination revealed diffuse bilateral crackles on inspiration, predominantly in the lower lobes, without wheezing. Chemistry profile and blood count were within normal limits. Room air arterial blood gas demonstrated pH 7.43, partial pressure of carbon dioxide (PCO2) 43 mmHg, and partial pressure of oxygen (PO2) 65 mmHg. Resting oxygen saturation was 92% and decreased to 87% after a 1-minute walk. Chest X-ray film (Figure 1) demonstrated bullous emphysema and fibrotic changes, predominantly in the lower lobes. High-resolution CT of the chest (Figure 2) was consistent with emphysema, with marked hyperinflation of both lower lobes. In addition, bibasilar scarring involving mainly the right middle lobe and lingular segments was noted. There was no evidence of interstitial fibrosis.

Quantitative perfusion lung scan showed reduced perfusion to the lower lung zones with virtual lack of perfusion to the left lower lobe and to the lower third of the right lung. In the upper lung zones, the perfusion was mildly heterogeneous. Overall perfusion to the left lung was 41%. Blood levels of C-reactive protein, alpha-1 antitrypsin, rheumatoid factor, antinuclear antibodies, antineutrophil cytoplasmic autoantibody and complement were within normal limits. Blood test for human immunodeficiency virus was negative. Findings on echocardiography were normal except for mild pulmonary hypertension, and heart catheterization demonstrated normal coronary arteries, pulmonary artery pressure of 40/13 mmHg (mean 29), and pulmonary wedge capillary pressure of 12 mmHg.

The patient was referred for lung transplantation, which was performed on December 15, 2003. ... On microscopic examination (Figure 3), lymphocytic foci, congestion, and multinuclear giant foreign body cells with a foreign substance in their cytoplasm were seen. The foreign substance, which was birefringent under polarized light, measured at least 5-10 µm, compatible with intravenously injected talc.


Discussion (consolidated abridgement):

NSFW:
Talc, a hydrous magnesium silicate, is used as a lubricating and diluting substance in many oral medications, such as methadone, methylphenidate, and pentazocine. Intravenous abuse of these oral medications can cause talcosis. The talc crystals are filtered by the pulmonary vascular bed, forming foreign body granulomas within the alveolar capillary walls and perivascular area (Gibbs et al 1992). The talc particles deposited in the lungs following intravenous administration are larger than those observed for inhaled talc, and always contain particles that exceed 10 µm (Feigin 1986). Progressive massive fibrosis (PMF) secondary to intravenous talc injection has been described with particles larger than 15 µm were only found in the mass lesion (Crouch and Churg 1983). In contrast to intravenous administration, inhaled talc is usually accompanied by other minerals, such as silica or asbestos, and it is these that seem to have the prominent clinical, pathologic and radiographic effect in the lungs (Lockey 1981). In cases of talc inhalation, only small particles, usually measuring up to 5 µm, are filtered by the bronchial tree, reach the peribronchial and perivascular regions or forming intraalveolar talc and asbestos bodies (Katzenstein and Askin 1997). The early restrictive and obstructive features of talcosis due to intravenous use may progress to severe, sometimes fatal, pulmonary disease, even in patients who have discontinued use of the drug (Pare et al 1989).

Typical findings on computed tomography (CT) include large and irregular attenuated nodules ("ground glass") in the middle and upper part of the lung, which can evolve to large masses or massive consolidations (Feigin 1986). The presence of lower-lobe panacinar emphysematous processes is more common in methylphenidate abusers (Stern et al 1994; Ward et al 2000). Birefringent talc crystals can be identified under polarized light in tissue samples.

Intravenous abuse of crushed oral medication can cause severe pulmonary disease. Pare and colleagues (1979, 1989) conducted a long-term follow-up of talcosis due to drug abuse of oral medication in 6 patients aged 23 to 51 years. All had severe progressive dyspnea despite their discontinuation of the drug. Chest radiographs revealed a gradual coalescence of nodules that eventually resulted in large, more or less homogeneous opacities in the perihilar and upper lobe regions. With time, hypertranslucency, oligemia, and bullae, mostly in the lower lung regions, became prominent. Pneumothoraces developed in 3 patients. Early pulmonary function tests demonstrated a combined restrictive and obstructive pattern, with no evidence of hyperinflation in most of the patients. However, long-term follow-up revealed rapidly progressive emphysematous features, namely, severe airflow obstruction, air trapping, and reduced diffusing capacity. Pathologic examination showed lung destruction, granuloma formation, and marked fibrosis. In a similar study, Sieniewicz and Nidecker (1980) described 4 patients with conglomerate pulmonary disease associated with intravenous injection of crushed methadone tablets. Chest X-ray film showed a micronodular pattern in 3 cases which later blended into masses in the upper lobes. The remaining patient had mediastinal adenopathy followed by the development of bilateral pneumothoraces.

The patient described here had progressive dyspnea despite discontinuation of drug abuse. Her lung functions were compatible with severe emphysema, and chest CT revealed an emphysematous pattern in the base of the lung but without nodules or masses and no evidence of interstitial fibrosis. .... In our patient, the lower lobe emphysema seemed to be compatible with her history of talc injection.

Our review of the literature yielded 2 cases of lung transplantation in patients with pulmonary talcosis secondary to intravenous drug abuse. In the case described by Cook and colleagues (1998), the pulmonary talcosis recurred 18 months following single-lung transplantation. After the transbronchial biopsy showed evidence of talcosis in the transplanted lung, the patient, a 48-year-old former intravenous methylphenidate abuser, admitted to recurrent intravenous drug abuse. The second patient was one of a series of intravenous oral drug abusers described by Stern and colleagues (1994). The patient underwent single-lung transplantation for basilar emphysema caused by intravenous injection of crushed methylphenidate tablets. The extracted lung was examined pathologically, but the authors provided no clinical data on this case. Recently, Fields and colleagues (2005) described a 24-year-old woman after bilateral lung transplantation for cystic fibrosis in whom microcrystalline cellulose embolization was detected on routine transbronchial biopsy. The patient admitted injecting crushed promethazine tablets through her intravenous port in order to control severe nausea caused by cytomegaloviral gastritis. She had no history of intravenous drug abuse, and histological examination of her native lungs was negative for intravascular or parenchymal foreign material.



Figure 1: Chest X-ray film. A. Before transplantation, showing bilateral hyperinflation. Note also the increased interstitial marking and scarring in the basilar portions. B. Two months after left lung transplantation, showing well-inflated left lung.
picrender.fcgi


Figure 2: CT scan of the chest demonstrating severe emphysematous changes with bullous formation and scarring.
picrender.fcgi


Figure 3: Pathologic study of the extracted lung. A. Note focal interstitial lymphocytic infiltrates (lower-left field) and giant foreign cells (arrows) with evidence of foreign material in the cytoplasm (hematoxylineosin; magnification × 200). B. Polarized particles in the interstitium and cytoplasm of the giant cells can be seen (magnification × 100).
picrender.fcgi
 
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Tarictic; that is a really interesting article. 200mg alprazolam over 6 days!! 16 bars a day! IMO no patient should ever have access to 100 Xanax bars. They do bottles of 50 here, but there are always issues of "lost" tablets.

I've got another 10 or so case studies lined up for the next couple of weeks so stay tuned.....

PS. Requesting the following for those with Journal access;

REQUESTS:

Bruce, R. D. (2008). "Case series of buprenorphine injectors in Kuala Lumpur, Malaysia.(Clinical report)." The American journal of drug and alcohol abuse 34(4): 511.

Dupont, B. and E. Drouhet (1985). "Cutaneous, ocular, and osteoarticular candidiasis in heroin addicts: new clinical and therapeutic aspects in 38 patients." The Journal of infectious diseases 152(3): 577-591.

Ebright, J. and B. Pieper (2002). "Skin and soft tissue infections in injection drug users." Infectious disease clinics of North America 16(3): 697-712.

Kalka-Moll, W. M., U. Aurbach, et al. (2007). "Wound botulism in injection drug users.(Letter to the editor)(Clinical report)." Emerging Infectious Diseases 13(6): 942(2).

Merrison, A. F. A., K. E. Chidley, et al. (2002). "Wound botulism associated with subcutaneous drug use. (Lesson of the week)." British Medical Journal 325(7371): 1020(2).

Lann, M. A. and D. K. Molina (2009). "A Fatal Case of Benzodiazepine Withdrawal." The American Journal of Forensic Medicine and Pathology 30(2): 177-179 10.1097/PAF.0b013e3181875aa0.
 
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Tarictic; that is a really interesting article. 200mg alprazolam over 6 days!! 16 bars a day! IMO no patient should ever have access to 100 Xanax bars. They do bottles of 50 here, but there are always issues of "lost" tablets.

I've got another 10 or so case studies lined up for the next couple of weeks so stay tuned.....

PS. Requesting the following for those with Journal access;

REQUESTS:

Bruce, R. D. (2008). "Case series of buprenorphine injectors in Kuala Lumpur, Malaysia.(Clinical report)." The American journal of drug and alcohol abuse 34(4): 511.

Dupont, B. and E. Drouhet (1985). "Cutaneous, ocular, and osteoarticular candidiasis in heroin addicts: new clinical and therapeutic aspects in 38 patients." The Journal of infectious diseases 152(3): 577-591.

Ebright, J. and B. Pieper (2002). "Skin and soft tissue infections in injection drug users." Infectious disease clinics of North America 16(3): 697-712.

Kalka-Moll, W. M., U. Aurbach, et al. (2007). "Wound botulism in injection drug users.(Letter to the editor)(Clinical report)." Emerging Infectious Diseases 13(6): 942(2).

Merrison, A. F. A., K. E. Chidley, et al. (2002). "Wound botulism associated with subcutaneous drug use. (Lesson of the week)." British Medical Journal 325(7371): 1020(2).

Lann, M. A. and D. K. Molina (2009). "A Fatal Case of Benzodiazepine Withdrawal." The American Journal of Forensic Medicine and Pathology 30(2): 177-179 10.1097/PAF.0b013e3181875aa0.

*Applause*

Malaysian buprenorphine injectors? Sounds interesting, indeed.
 
Fungus in lemon juice introduced via IV causes blindness within a month...

Posterior retinal hole secondary to a candida retinitis
Alvarez-Suarez ML, Sanchez-Tabar L et al, 2005, The Spanish Ophthalmology society files (Archivos de la Sociedad Espanola de Oftalmologia) 80(7): 421-4.
http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0365-66912005000700008&lng=es&nrm=iso&tlng=es&skpa=on


ABSTRACT:
CASE REPORT: We describe the case of a 36-year-old man with a history of intravenous heroin use, who was HIV negative. Left ocular examination disclosed a focal candida retinitis in the posterior pole associated with vitritis and moderate iritis. Treatment with fluconazole inactived the chorio-retinal lesion and resolved the vitritis, but developed an inner limiting membrane contraction over the macula. Two years later, vitreous traction produced a retinal hole that needed argon laser photocoagulation. DISCUSSION: Candida retinitis which penetrates into the vitreous cavity can produce retinal holes by vitreous traction over the lesion.


CLINICAL CASE (rough translation)
Male 30 age that attends emergency for loss of vision, redness and pain in left eye (OS) of 3 days of evolution. The patient also concerns fever approximately 20 days ago and is heroinómano sporadic recognizing a last episode of several Brown heroin injections approximately 25 days ago.

Exploration of the right eye (OD) was normal, while in the left eye (OS) there was an accompanied by a most focus of retinitis with localized vitritis previous Uveitis. The clinical exploration only detected febrícula and a few small bilateral latero-cervicales adenopathy.

Eye injuries were typical of candidiasis started hospital treatment with intravenous, fluconazole at dose of 200 mg / 24 h, and an eye pattern of corticosteroids and midriáticos topics. Complementary studies showed a Leukocytosis with normal formula (no neutropenia), a proteinograma with discrete increase in the alpha-2-globulins and some negative hepatitis B and HIV markers. The blood cultures, Lues, toxoplasma, CMV, serology and BK sputum and urine samples were also negative. Puncture a cervical Lymphadenopathy showed a reactive lymphadenitis with little activity blastic.

The box improved gradually with fever, the cilium-conjunctival reaction and inflammation of anterior chamber disappearance. The back of eye could see a good scarring of the prerretiniana injury and treatment was completed with oral fluconazole other 4 weeks.

At the end of treatment visual acuity in OI was 0.6, with a vitreous clear and with the focus of totally scar retinitis but associated vitreous traction which produced a marked contraction of the internal level macular limiting membrane ( fig. 1 ). 2 Years occurred a retinal hole where griped retino-vitreous scar focus, that the patient detected by sudden clinic in metamorfopsia. The tear was accompanied by a small detachment surrounded with two barriers of laser argon ( figs. 2 and 3 ) and was followed by a marked visual improvement until 0.9 release of traction on limiting internal.


DISCUSSION
NSFW:

Eye thrush is a pathology that typically appears in drug addicts injecting, in immunosuppressed patients, and when there is a long-term use of catheter. These last two risk factors seems to have moved to the use of heroin, the main cause of endophthalmitis Candida in the 1980s and early 90 (2). They are also predisposing causes hemodialysis, corticosteroids, a prolonged (especially associated to abdominal surgery) antibioterapia, diabetes, pregnancy, alcoholism, liver failure, the post-partum, prematurity, manipulation genitourinaria e even described in people healthy (2).

The diagnosis is set by the special characteristics of risk in these patients, the morphological aspect of the retino-vitreous lesions and often, by the coexistence of other associated manifestations of systemic candidiasis (3). Retinitis Candidal appears as an injury blanco-amarillentas coriorretinianas located mainly in later pole. The retinitis progresses and crosses the internal limiting membrane to spread itself over ... to the vitreous ... and can (cause major) complications including retinal detachment, retraction of the limiting internal, membranes fibrovasculares and ptisis bulbi (1.3). An intense iritis and sinequiante is also typical and translates a sterile in anterior chamber inflammatory reaction.

Most of these patients with eye affectation typically present other clinical signs as inflammation ... The treatment of patients ... relies on fluconazole po or iv, at a dose of 100-400mg/day for 4-8 weeks (1,2). The vitrectomy is done in case of poor response to the fluconazole, presence of severe vitritis and for the management of vítreo-retinianas complications as grout persistent vitreous haze, retinal detachment, membrane epirretiniana macular and neovascularization (4). A significant visual loss by contraction of the internal limiting membrane would also be an indication of peeled of the constraint with the help of the biological stains. At the time of the vitrectomy amphotericin B intravítrea, can be associated corticoids intraocular and complemented by oral or intravenous fluconazole (2).


fig. 1 Folds macular in limiting membrane internal due to the vitreous traction on the focus scar of retinitis.

fig. 2 & 3 Retinal hole in secondary later pole the focus of candidiasis (before and after fotocoagular).
 

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^ A VERY good reason why only sterelised lemon juice should be used when prepping brown heroin for IV. If the Candida fungus is in the lemon juice (and heat will not kill fungi easily) and you introduce it directly into the bloodstream via IV (bypassing normal defensive barriers including acids/enzymes), the fungus can thrive in the body, typically growing on the retina until vision is permanently occluded. Nuff said :)

PS. If someone can translate this properly (or just fix up glaring errors in the automatic translation) then that would be much appreciated. The 5 paragraphs of the CASE STUDY heading and the figure 1 and 2 captions is most important. Thanks :)
 
It hurts like a son of a bitch to subcutaneously inject a drug, how can people do that to themselves willingly?

I can answer your question. After IV"ing heroin for many years, I lost all of my veins. I got clean for a number of years, but I started using again. When I starting using again there was no more "Mexican Brown" It was black tar, and at first I just snorted it, but I couldn't stand the way it made my nose burn, so I picked up a rig again and decided to try and find a vein. That worked a few times, but when my vein was gone, I started to just inject the tar in my arm like a flu shot. I can remember it burning so bad I would be crying and I would have to stop and go somewhere else, but I was sick and I had to get well so I did what I had to do. I don't know what the fuck they put in that black tar but It's poison. I haven't touched a needle since July 1, 2002 and I still have scars all over my arms and butt, and I have huge lumps all over my butt where I shot up. Those lumps hurt for months, and today, if I ever want to pick up a needle, all I have to do is look at the scars and remember the pain. It's called obession I was obsessed with the needle. I don't know how else to desribe it. I never thought when I was growing up that I would one day mutilate my body, but thats where I ended up. When I finally had enough I went on Methadone Maintenance and I haven't had that obsession since..

LillyF40%)
 
I had just one experience with fentanyl. 50 mcgs i.v, It's too good to be true!!!! It's a powerfull drug and should be used wisely. It was my first opiate. Love'd it! Can't believe people using mgs of this stuff at once.
 
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I have only injected 15-20 times (mostly during experimentation). However after reading this thread, I will most likely never IV again unless I acquire proper IV medications (ampules), and only in specific veins.

Thank you, djsim.
 
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