The present study hypothesizes that a bacterial cocaine esterase with high catalytic efficiency would provide rapid and robust protection from cocaine-induced convulsions, epileptogenic activity, and lethality. Presently, there are no treatments to eliminate the toxic effects of cocaine. Jutkiewicz, Emily M Baladi, Michelle G Cooper, Ziva D Narasimhan, Diwahar Sunahara, Roger K Woods, James HĬocaine toxicity results in cardiovascular complications, seizures, and death and accounts for approximately 20% of drug-related emergency department visits every year.
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Histological examination of bioptic samples from the sinonasal area and oral cavity represents the mainstay for the diagnosis of IgG4-RD involvement of the midline structures.Ī bacterial cocaine esterase protects against cocaine-induced epileptogenic activity and lethality. Storiform fibrosis and an IgG4+/IgG + plasma cell ratio >20% on histological examination, however, were observed only in patients with IgG4-RD. Rather, all 11 patients had elevated blood plasmablast concentrations, and several patients with GPA and CIMDL had elevated serum IgG4 levels. Increased serum IgG4 and plasmablasts levels were not specific for IgG4-RD.
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We found no clinical, endoscopic, or radiological findings specific for IgG4-RD. Five patients with granulomatosis with polyangiitis (GPA), three with cocaine-induced midline destructive lesions (CIMDL), and three with IgG4-RD were studied. The histological studies included immunostaining studies to assess the number of IgG4 + plasma cells/HPF for calculation of the IgG4+/IgG + plasma cell ratio. All patients underwent serum IgG4 measurement, flow cytometry for circulating plasmablast counts, nasal endoscopy, radiological studies, and histological evaluation of tissue specimens. We studied 11 consecutive patients with erosive and/or tumefactive lesions of the midline structures referred to our tertiary care center. We examined the clinical, serological, endoscopic, radiological, and histological features that might be of utility in distinguishing IgG4-RD from other forms of inflammatory conditions with the potential to involve the sinonasal area and the oral cavity.
WOLF EEL BITES COKE CAN SERIES
Lanzillotta, Marco Campochiaro, Corrado Trimarchi, Matteo Arrigoni, Gianluigi Gerevini, Simonetta Milani, Raffaella Bozzolo, Enrica Biafora, Matteo Venturini, Elena Cicalese, Maria Pia Stone, John H Sabbadini, Maria Grazia Della-Torre, EmanuelĪ series of destructive and tumefactive lesions of the midline structures have been recently added to the spectrum of IgG4-related disease (IgG4-RD). To the best of our knowledge, this is the first report of an encephalocele likely induced solely by cocaine abuse.ĭeconstructing IgG4-related disease involvement of midline structures: Comparison to common mimickers. Histopathological analysis of the necrotic tissue and the absence of renal or pulmonary disease also indicated that the patient did not suffer from Wegener granulomatosis, a known cause of spontaneous intranasal lesions. Alternative causes of an encephalocele, including trauma, surgery, and congenital malformation, were ruled out in this patient. The patient made a good recovery after treatment. The patient was treated with intravenous antibiotics and underwent a repair of his cranial defect and resection of the encephalocele. The patient had a 30-year history of intranasal cocaine abuse, and his urine tested positive for the presence of cocaine on admission. On computed tomography, extensive destruction of the anterior cranial fossa was observed. A 56-year-old man presented with altered mental status and cerebritis secondary to the presence of an intranasal encephalocele. We report a case of an encephalocele secondary to cocaine use and its associated complications. Coupled with a prolonged chronic infection of intranasal and anterior skull base regions, an encephalocele can be formed.
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This process occurs secondary to myriad mechanisms, including ischemic necrosis, irritation by chemical adulterants, and direct trauma during its administration.
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The abuse of cocaine can lead to significant destruction of midline craniofacial structures. Cocaine-induced encephalocele: case report and literature review.