Myocardial damage and rhabdomyolysis associated with prolonged hypoxic coma following opiate overdose.

CASE REPORT: We report a case of biopsy proven myocardial damage after opiate-induced rhabdomyolysis. Myocardial biopsy showed focal lesions formed by small mononuclear inflammatory cells with a few neutrophils, associated with degenerated and necrotic myocardial fibers, interstitial edema and congestion of intrinsic blood vessels. These findings were similar to those seen with other drug overdoses if combined with strenuous muscular effort or hypoxic coma. We hypothesize that myocardial damage is a consequence of intracapillary myohypoxia associated with prolonged hypoxic coma following opiate overdose.

[Cocaine poisoning in acute renal insufficiency]. / Intossicazione da cocaina e insufficienza renale acuta.

We report the case of a young man who developed acute renal failure after ingestion of cocaine wrapped in foil. We did not find either clinical or clear biochemical signs of rhabdomyolysis. The possible role of high blood cocaine level in the development of acute renal failure has been speculated and a direct vasoconstrictive effect on renal vessels followed by acute tubular necrosis has been hypothesized.

[Rhabdomyolysis during acute poisoning with drugs and narcotics. Experience with 7 clinical cases]. / Rabdomiolisi in corso di intossicazione acuta da farmaci e sostanze stupefacenti. Esperienza su 7 casi clinici.

Numerous and extremely varied conditions (intense muscular activity, ischemia, metabolic and genetic disorders, infections, immunological diseases and toxic causes) may play a role in the genesis of non-traumatic rhabdomyolysis. Over the past years there has been an increased number of reports of forms due to drug or narcotic intoxication. Seven cases of rhabdomyolysis are reported in patients admitted to emergency wards in a state of coma due to heroin overdose (4 cases), cocaine overdose (1 case), carbamazepin (1 case), and tricyclic anti-depressives (1 case). In all cases it was possible to hypothesise a multifactorial pathogenesis of the disease in which other factors, such as acidosis, hypoxia, hypothermia and compression of the muscle mass during coma, were associated with the direct toxic damage caused by the drug. The most frequent complication was acute renal failure. One case of myocardial involvement with non-Q infarction characteristics was also observed.

[Myocardial involvement in rhabdomyolysis caused by acute heroin intoxication]. / Interessamento miocardico in corso di rabdomiolisi da intossicazione acuta da eroina.

It is well known that heroin overdose may cause rhabdomyolysis. Sometimes a myocardial involvement complicates its course. We report a case of heroin intoxication followed by rhabdomyolysis associated with myocardial injury, with symptoms, laboratory findings, ECG and echocardiography features of non-Q wave infarction. However, a 201 Tl myocardial scintigraphy, performed after patient discharging, did not show any abnormality. We think that heroin has a direct myotoxic effect on both myocardium and skeletal muscle. Yet we cannot exclude that hypoxia, acidosis, vasoconstrictive substances released by muscle necrosis, or hypersensitivity reactions associated with heroin or some of its adulterants are involved in myocardial injury.

[Solitary ulcer syndrome: anatomo-clinical aspects]. / Sindrome dell'ulcera solitaria: quadri anatomo-clinici.

The clinical, radiological, endoscopic and histological aspects of a case of Isolated Ulcer Syndrome (IUS) of the rectum are examined. For over a decade and on the basis of its clinical, radiological, endoscopic and histological features, this condition was considered Ulcerous Rectocolitis and treated as such. The case presented serves to highlight the possibility of confusing this ulcer with other inflammatory colorectal conditions if only the clinical, radiological and endoscopic pictures are taken into consideration. The importance of histological examination of numerous bioptic samples is emphasised as essential for accurate diagnosis.