1. ILIOFEMORAL VENOUS THROMBOSIS AMONG INJECTING USERS IN SKOPJE B.Pavlovski, C.Bozinovska, A.Cibisev, D.Petrovski, N.Popovski, F.Licoska, V.Jordanov Clinic for Toxicology and urgent Internal medicine. Clinical Centre. Skopje. R.Macedonia ORAL PRESENTATION I National Congress on Clinical Toxicology, Sofia,October 23-25, 2003

2. BACKGROUND 1.  GENERAL VIEW  NARCOTICS ARE COMING IN ALL TRANSITION COUNTRIES  MARIJUANA  SYNTHETIC NARCOTICS-ECSTASY  HEROIN  COMMON PROBLEM- COMMON INTEREST

3. BACKGROUND 2. MAIN CARACTERISTICS OF ADDICTS IN SKOPJE REGION 1.ADDICTS START WITH MARIJUANA 2.FASTLY CROSSING ON HEROIN ABUSE 3.STARTING WITH HEROIN 4. YOUNG PEOPLE. THE MEAN AGE 21 YEAR

4. HEROIN ADDICTS IN OUR DAILY TOXICOLOGICAL PRACTICE: 1.HEROIN OVER DOSES 2.CRISIS OF ABSTINENCE 3.FOR DETOXIFICATION-PROGRAMME FOR CESSATION 4.VASCULAR COMPLICATIONS

5.  DURING RECENT FOUR YEARS 22 PATIENTS, CURRENT INTRAVENOUS HEROIN ADDICTS WITH SEVERE DAMAGE TO THE GROIN VESSELS WERE TREATED IN OUR CLINIC. ALL OF THE PATIENTS WERE CHRONIC INJECTING DRUG USERS WITH MEDIAN INJECTION DURATION OVER FOUR YEARS

6. ANALYTICAL APPROACH ON DIFFERENT WAY OF INJECTION: 1.IN THE BEGINNING, THE MOST USED REGION OF INJECTING HEROIN IS REGION OF VEIN MEDIANA CUBITI, BASILICA, CEPHALICA 2.VENNE MANUS – RETE VENOSUM PALMARE 3.GROIN VESSELS: VEIN FEMORALIS, VEIN SAPHENA MAGNA 4.VEIN POPLITEA, VEIN SAPHENA PARVA 5.RETE VENOSUM DORSALIS PEDIS, RETE VENOSUM CALCANEI

7. 4 patientsBilateral damage of wein femoralis 12 patientsUnilateral injury of wein femoralis - left 5 patientsUnilateral injury of wein femoralis-right 1 patientDamage of wein poplitea - left THE PLACE OF VESSELS DAMAGE

8.  INJECTING HEROIN IN REGION IN GROIN VESSELS CLEARLY SHOWED – LONG TERM ABUSE OF HEROIN AND DESTRUCTED VEIN SYSTEM.  YOUNG PEOPLE - OLD ADDICTS

9. THE AIM OF THIS STUDY: TO EVALUATE THERAPEUTIC APPROACH IN THIS GROUP OF PATIENTS

10. MATERIAL AND METHODS:  22 PATIENTS, ACTIVE HEROIN USERS WITH THROMBOPHLEBITIS WERE OBSERVED IN LAST FOUR YEARS.  CLINICAL PICTURE: DOMINANT SIGNS AND SYMPTOMS WERE: HARDLY WALK, SWELLING FOOT, ULCERS, TEMPERATURE AND PAIN IN THE INFERIOR EXTREMITIES.

11. Patients 22 Male 16 Female 6 Age 25 Time of abuse: over 4 years NUMBER OF PATIENTS, SEX, AGE AND TIME OF ABUSE STATISTICAL ANALYSIS

12. AT EVERY PATIENT WERE MADE: 1.ROUTINE LABORATORY-BLOOD AND URINE TESTS 1.TOXICOLOGICAL ANALYSIS-TO GIVE PROOF-HEROIN,METHADON,BZ 2.MARKERS OF HEPATITIS A,B,C 3.DOPPLER – ECHO ULTRASOUND-PLACE OF VEIN OCLUSION

13. TREATMENT:  ALL PATIENTS WERE TREATED WITH SUBCUTANEOUS LMWH – LOW – MOLECULAR – WEIGHT HEPARIN (FRAHEPAN, 2x3000 IU FOR 4 WEEKS),  ANTIBIOTICS-PENICILLIN, AND CIPROFLOXACIN AND METRONIDAZOL  LOCAR CARE - WITH COMPRESS OF ACIIDI BORICI AND UNQ-HEPATHROMBIN FRAHEPAN (CERTOPARINUM NATRICUM)

14. RESULTS:  ALL PATIENTS TESTED FOR HEPATITIS C VIRUS WERE SEROPOSITIVE.  SATISFACTORY CLINICAL RESPONSE –  12 PATIENTS,  6 PATIENTS HAD PERSISTENTLY SWOLLEN LEG  4 WERE LOST TO FOLLOW UP  ONE DRAINAGE OF ABSCESS IN REGION OF VEIN POPLITEA WERE CARRIED OUT

15. CONCLUSION:  FOR SATISFACTORY CLINICAL RESPONSE WE PREFERE TO CONTINUE WITH ANTICOAGULANT WITH FRAHEPAN THERAPY FOR AT LEAST THREE MONTHS.  METHADONE AS SUPPORTING TREATMENT SHOULD BE GIVEN IN SELECTED PATIENTS.  IT IS VERY DIFFICULT TO FOLLOW ADDICTS, THEY RARELY COME AT REGULAR CONTROL INVESTIGATION