Crystal methamphetamine-induced acute pulmonary edema: a case report.

"Crystal methamphetamine" is a crystalline form of amphetamine, the abuse of which is growing rapidly in popularity in Japan, Hawaii and the West Coast. Drug experts and law enforcement officials say that the use of crystal meth is spreading east from California. It may produce permanent addiction and can produce violent schizophrenic behavior. Introduced along the Leeward Coast of Hawaii about 3 years ago, it is now being used throughout Oahu and is starting to rival cocaine as the illicit drug of choice in Hawaii. It is also the major drug problem in Japan, where the powder form is called "shabu." The smoking of crystal ("ice") in a glass pipe is more common in Hawaii, whereas other routes of administration, such as snorting or intravenous use, are more common on the West Coast. We present the case of a young woman who was admitted to Kaiser Moanalua Medical Center with near fatal acute pulmonary edema consequent to the use of crystal meth.

Chronic persistent pulmonary embolism. Report of three cases.

Nonresolution of acute pulmonary embolism and resultant chronic persistent pulmonary occlusion is uncommon; documentation of its occurrence in patients receiving anticoagulants is sparse. We report three cases with hemodynamic data and follow-up of up to seven years. All patients had mild to moderate dyspnea on exertion. All patients had normal resting pulmonary artery pressures; two patients demonstrated pulmonary hypertension with exercise. One patient underwent successful thromboendarterectomy but had subsequent reocclusion secondary to in situ thrombosis. With all patients receiving long-term anticoagulant therapy, there was no clinical recurrence of embolization or progression of symptoms. Patients with chronic persistent pulmonary embolism should be identified and should receive long-term follow-up. Therapy aimed at prevention of recurrent embolization is required. Pulmonary thromboendarterectomy is indicated for selected patients.