Psychiatric comorbidities in a young man with subacute myelopathy induced by abusive nitrous oxide consumption: a case report.

Nitrous oxide (N2O), a long-standing anesthetic, is known for its recreational use, and its consumption is on the rise. Several case studies have reported neurological and psychiatric complications of N2O use. To date, however, there has not been a study using standardized diagnostic procedures to assess psychiatric comorbidities in a patient consuming N2O. Here, we report about a 35-year-old male with magnetic resonance imaging confirmed subacute myelopathy induced by N2O consumption, who suffered from comorbid cannabinoid and nicotine dependence as well as abuse of amphetamines, cocaine, lysergic acid diethylamide, and ketamine. Additionally, there was evidence of a preceding transient psychotic and depressive episode induced by synthetic cannabinoid abuse. In summary, this case raises awareness of an important mechanism of neural toxicity, with which physicians working in the field of substance-related disorders should be familiar. In fact, excluding N2O toxicity in patients with recognized substance-related disorders and new neurological deficits is compulsory, as untreated for months the damage to the nervous system is at risk of becoming irreversible.

[Late results of coronary revascularization with saphenous vein and internal thoracic artery grafts]. / Veniniu ir arteriniu jungciu, suformuotu su skirtingomis vainikinemis arterijomis, isgyvenimas.

OBJECTIVE: To evaluate the patency of saphenous vein and internal thoracic artery grafts by coronary system using angiographies performed in symptomatic patients after coronary artery bypass grafting. MATERIAL AND METHODS: From 1999 to 2006, 685 patients (mean age, 59.1+/-11.8 years) had angiography of 538 internal thoracic and gastroepiploic artery and 1644 saphenous vein grafts. There were 580 (84.7%) males. The mean period from operation to the performance of reangiogram was 73.3+/-53.5 months. Graft failure was defined as >95% stenosis. The saphenous vein was grafted to the left anterior descending artery in 106 (6.4%), to the diagonal artery in 364 (22.1%), to the obtuse marginal artery in 629 (38.3%), and to the right coronary artery in 545 (33.1%) cases. RESULTS: During the study, 1496 (68.97%) grafts were patent, and 686 (31.0%) had failed. Unadjusted 1-, 5-, 10-, and >10-year patency was 91.0%, 89.9%, 90.1%, and 75% for internal thoracic arteries and 79.9%, 68.6%, 57.4%, and 51.0% for saphenous veins, respectively. CONCLUSIONS: Internal thoracic arteries demonstrate better patency than saphenous veins except when grafting moderately stenosed coronary arteries. When bypassing coronary arteries with less than 70% stenosis, saphenous veins may be a better choice.