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There are only few reports in the medical literature about side effects and toxicity of horse chestnut (Aesculus hippocastanum). We report a 15-year-old woman who was admitted to the hospital because of symptoms including: vomiting, dyspnea, burning in the nose and throat, and syncope, after intranasal snuff of powdered horse chestnut seeds. Laboratory tests showed no abnormalities. After 2 days of hospitalization the female was discharged home with subjective and objective improvement. Preparation and use of snuff is related to the tradition of the kashubian region. The powder formed from horse chestnuts, which is white in color, effects after about 5-10 minutes, and causes severe irritation of the nasal mucous membranes, which results in sneezing. Responsible for side effects is mainly aescin. The most frequently observed aescin intoxication symptoms were gastrointestinal irritation and allergic reactions. Intoxication by powdered seeds of horse chestnut used nasally as snuff may lead, as it was in our case, to sudden and self-limiting clinical symptoms. Supportive therapy and a short hospital observation seems to be sufficient in such cases.

Paper presents Polish Medical Society, Section of Clinical Toxicology position statement on the prehospital and hospital management in case of suspicion of intoxication with paracetamol.

Introduction: Despite the many side effects solutions of kitchen salt are still being used as efficient and safe homemade emetics., Case Reports: Saturated solutions of kitchen salt have been used by paramedics to provoke vomiting in two patients: a 50-years-old woman and a 44-years-old man. According to anamnesis patients received respectively around 330 and 500 g of dissolved kitchen salt. In both cases bloody emesis and bloody diarrhea, alteration of consciousness and low blood pressure were noted. Maximum blood sodium level was 177 and 173 mmol/l respectively. Due to signs of gastrointestinal bleeding gastric endoscopy was performed in both cases, which demonstrated widespread damage of gastric mucosa. Normalization of electrolyte disturbances and improvement of patients' status was achieved with intravenous infusion of 5% glucose. Both patients have been discharged to further outpatient treatment after 10-days hospitalization., Conclusions: 1. Use of salt kitchen solutions to induce emesis results in a high risk of life-threatening complications. 2. Particular emphasis must be put on training of paramedics in pre-hospital management of acute poisonings.

Unlabelled: The number of patients admitted to toxicological units due to acute liver failure (ALF) and acute-on-chronic liver failure (AoChLF) has been increasing in recent years. Various methods of extracorporeal liver support have been described in this paper, with particular emphasis on modified single pass albumin dialysis (SPAD)., Conclusions: 1. Single pass albumin dialysis (SPAD) is a promising method of extracorporeal liver support. 2. Due to widespread availability of continuous renal replacement therapy equipment it can be performed in most units providing intensive care. 3. No additional costs due to purchase of equipment or training of personnel are necessary to perform SPAD. 4. Further studies are necessary to establish optimal concentration of human albumin in dialysate and flow rates of blood and dialysate during the procedure. 5. Development of biocompatible replacement of human albumin would promote more frequent use of SPAD.

We have described three physicians aged 65-70 years, who had noticed during their insulintherapy significant, periodically recurrent variations of insulin requirement (max. 50 i.u./24h vs 25 i.u./24h) in the periods of 4-16 weeks. They had been characterized by similar diet and physical activity, stable normal body mass (av. BMI 24.6) and normal glycosylated hemoglobin (av. HbA1c 5.9%). The hypothesis was put forward that the cause of this phenomenon may be periodical changes in the incretin system activity or increased proliferation of pancreatic beta cells leading to decrease of insulin requirement.

Insulin-treated diabetes influences motor vehicle driving mainly through the possibility to induce hypoglycemia in patients. However, there has never been any consistent evidence to suggest that patients with insulin-treated diabetes cause significantly more accidents than the general population. Diabetes and its complications have very various individual courses in patients, because of that candidates for driver's license should always be qualified individually. Drivers with diabetes complications, especially the elderly, quite often themselves limit driving. The programme facilitating the diagnosis of early hypoglycemic symptoms--Blood Glucose Awareness Training--decreases road traffic collision number.

Fourteen patients were included to the albumin dialysis--MARS in the Clinic of Internal Medicine Geriatry and Clinical Toxicology in the years 2004-2006 because of acute intoxication with Amanita phalloides. The 26 procedures were done. Ten patients recovered, one was transplanted and three patients at the age from 68 to 79 (average 72.6) years died because of acute liver failure (21.4% cases). All deceased patients had significant higher plasma bilirubin level and INR in compare to other probants. The procedures of albumin dialysis caused significant lowering of blood glucose level, red blood cells and platelets, but without the need for intervention.

Unlabelled: Tiagabine is a derivative of nipecotinic acid used in the therapy of partial seizures, partial seizures with secondary generalization, stress disorder, psychosis and cocaine dependence. The pharmacologic effect of the drug is achieved by inhibition of reuptake of gamma aminobutyric acid (GABA) into glial cells and neurons, without permanent increase in whole brain GABA concentration. Symptoms of acute tiagabine overdose include seizures, coma, respiratory depression ' and less often dystonias, involuntary movements, somnolence, agitation, tachycardia and increase or decrease of blood pressure. Two cases of acute tiagabine overdose have been described in the paper presenting with partial and generalized seizures which were managed with benzodiazepines., Conclusions: The onset of symptoms of acute tiagabine overdose is rapid with resolution within first 24 hours from exposure. Acute tiagabine poisoning may present with a wide variety of neurological symptoms. Administration of benzodiazepines may improve the outcome of overdose.

Age-standardised cancer incidence rates in reproductive system, digestive system and respiratory system were analyzed taking into account the statistics for 38 States of USA (1996-2001), European Union (2006) and Europe (2006). Age-standardized incidence rate in the reproductive system was higher in comparison with the corresponding rates for digestive and respiratory systems. The authors put under discussion a hypothesis of this phenomenon.

Seventy six patients (55 males and 21 females) aged from 39 to 89 (mean 63.7 +/- 9.7) years with multiple primary cancers were described. Larynx cancer was the most commonly seen multiple primary cancer component (35.5%) followed by lung cancer (12.5%). Combination of larynx cancer and lung cancer was the most often observed connection (21.1%). In seventeen patients two cancers were diagnosed concurrently. In other cases the interval between two cancers varied from 1 to 24 (mean 6.9 +/- 6.1) years. Smoking rate was 80.3% at diagnosis of the second cancer and only 10 patients (13.1%) quit smoking when first cancer was recognized. The results of the research indicate the necessity of conducting wide prophylactic actions.

Unlabelled: A 31-year-old female who have snorted one "line" of cocaine hydrochloride (approximately 35 mg), for the first time in her life, was admitted to the hospital because of acute onset of right hemiplegia and left hemiparesis evolving into quadriplegia. Motor aphasia, right eye-ball divergent strabismus and right mouth recess lowering were also observed., Conclusions: A first time mucosal administration of cocaine hydrochloride even in low dose can cause severe neurological complications like quadriplegia and aphasia. Cocaine-associated stroke can be a diagnostic problem in the emergency room. Unconscious patients or those with acute onset of neurological disorders can form a real diagnostic challenge, especially when there is no evidence of previous drug taking.

Spontaneous regression of malignant tumours is a rare and enigmatic phenomenon. We reviewed the cases of spontaneous regression of cancer in medical literature according to MEDLINE database in the period 1988-2006 and compared them with similar reviews from 1900-1987 period. The number of reported cases of spontaneous regression increased steadily in XX century, probably due to a rising interest in this problem and new possibilities of radiological and biopsy examinations. Spontaneous regression of malignancy was reported in almost all types of human cancer, although the greatest number of cases in years 1988-2006 were reported in patients with nephroblastoma, renal cell carcinoma, malignant melanoma, lymphoma. Elucidation of the process of spontaneous regression offers the possibility of improved methods of preventing andlor treating cancer.

A case of the patient who underwent by bilateral adrenalectomy at the age of 37 and 56 years due to recurrent pheochromocytoma has been described. The authors stress that follow-up of patients after adrenalectomy is mandatory on lifetime basis.

The enzymatic investigations were done in 56 patients, including 30 females and 26 males in the age range 18-76 (mean 52 +/- 12). Thirty two of them (57.1%) suffered from type 2 diabetes. All the patients consumed voluntarily Tricholoma equestre; 43 of them only once from 70 to 150 g, and 13 patients from two to four times for 4 consecutive days (between 300 g and 1200 g). Twenty seven patients, because of hyperlipidemia, took statins (simvastatin á 20 mg--15 patients, lovastatin á 20 mg--6 patients, fluvastatin á 80 mg--3 patients, atorvastatin á 20 mg--3 patients) and seven took fibrates (4 patients-- enofibrate á 267 mg, and 3 patients--ciprofibrate á 100 mg). Two subjects ingested both simvastatin á 20 mg and fenofibrate á 267 mg. Three to six days after the last mushroom dish, blood samples were taken from patients to examine the serum creatine kinase (CK), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities. The biochemical analyses were performed by means of the kinetic spectrophotometry using the autoanalyzer Architect ClI8200 with Abbott proprietary reagents. Statistical analysis was performed by means of t-Student test. Tricholoma equestre taken by patients in a total amount from 70 g to 1200 g for four consecutive days did not cause the significant increase in serum CK, AST, ALT activities. Similar mushroom dishes consumed by patients constantly using statins or fibrates also did not increase significantly the serum CK, AST, ALT activities. Patients treated with statins or fibrates may eat Tricholoma equestre in reasonable amount according to the established tradition.

The purpose of the study was to explore relationship between the menstrual cycle and suicidal attempts. A study was performed on 151 fertile females who were admitted to the Clinic of Internal Diseases and Acute Poisonings Medical University of Gdańsk during the years 2002-2003 because of suicidal attempts. The inclusion criteria were as follows: fertility, regular menstrual cycle, lack of oral contraceptives, willingness to attend the follow up and willingness to see a psychiatrist. Using the anamnesis the patients were also grouped according to the menstrual cycle into menstrual, follicular, midcycle and luteal phase. According to psychiatric investigations every female was classified to the respective category: situational reaction, depression, schizophrenia, alcohol addiction and sociopathy. Severity of intoxication was classified according to Poisoning Severity Score (PSS). Statistical analysis was done with the use of chi-square test with Pearson correction. Suicidal attempts were the most frequent among females during menstrual phase. The most common diagnosis in females who have attempted suicide were situational reactions which dominated in patients aged 14-21 years. Among attempters with the psychiatric diagnosis of depression, schizophrenia and alcohol addiction the degree of poisoning was significantly more severe than in the patients with situational reaction.

A 31-year-old female bodybuilder who was admitted to the Clinic because of deep coma and hypoglycaemia was presented. For last six weeks she had been preparing for a competition doing aerobic and anaerobic exercises, ingesting rich-protein and low-carbohydrate diet and administering a low dose of somatotropin every day. Even for the regional competitions there is a need for exact doping check among young athletes. Growth hormone in a small dosage taken together with low-carbohydrate and rich-protein diet can provoke deep hypoglicemia among people who use it for doping purposes.

Unlabelled: Many authors have noticed an increase in suicidal intoxication with baclofen, a lipophilic analog of gamma-aminobutyric acid (GABA). Although morbidity and mortality is low in baclofen overdosage however may cause serious respiratory failure as also cardiac and neurological system disturbances. The aim of the study was to evaluate some clinical aspects of acute intoxication with baclofen. We analyzed 18 patients (8 females and 10 males) aged from 15 to 58 (mean 33+/-15.4) years. Patients were admitted to the Department of Toxicology in the years 1996-2003 because of suicidal intoxication with baclofen. Number of patients intoxicated with baclofen during the last four years of analysis was two times more than in the first four years. The doses of baclofen were from 150 to 1500 (mean 388) mg. There were twelve patients (66%) admitted to the Clinic in deep coma (III and IV grade of Matthew scale) with the hyporeflexia and low muscle tone. Acute respiratory failure which required mechanical ventilation (6 to 96--mean 53.2 hours) was observed in 10 cases (55.5%). Cardiac abnormalities included bradycardia (44.4%), hypertension (33.0%) and hypotension (5.5%). Toxic psychoses were observed in 6 cases (33.3%). Flumazenil administration had no impact on clinical advancement of coma. An increase in creatine kinase activity was observed in 12 patients (66.6%)., Conclusions: There was no correlation between the dosage of baclofen and the clinical outcome. Baclofen poisoned patients should be admitted to hospitals with adequate medical equipment, especially respirators.

Unlabelled: Animal toxicity study of Tricholoma equestre mushrooms stored for 12 months at (-)20 degrees C was performed using 30 male BALB/c mice. Three groups of 5 mice each were given suspension of T. equestre powder in water, boiled aqueous extract and chloroform-methanol extract dissolved in Miglyol 812 by gavage for three consecutive days. Mice in control groups were given water, Miglyol 812 and p-phenylenediamine (CAS 106-50-3). Creatine kinase activity was determined in serum collected 72 hours after the final dose. Mean activity of serum creatine kinase in mice treated with T. equestre powder, aqueous extract, chloroform-methanol extract and Miglyol 812 were 157 +/- 93, 129 +/- 30, 96 +/- 38, 111 +/- 66 U/L respectively and did not differ significantly from mean activity in mice which were given water (107 +/- 38 U/L). Mean serum creatine kinase activity in p-phenylenediamine group (265 +/- 63 U/L) was significantly higher than in group treated with water (p<0.01)., Conclusion: Extracts of Tricholoma equestre mushrooms stored for 12 months at (-)20 degrees C did not cause rhabdomyolysis in male BALB/c mice.

Unlabelled: Acute ethanol intoxication and pathologies resulting from its chronic usage are among the most common causes of hospitalization in many countries, affecting all age groups, both genders and almost all social groups. The aim of the study was to evaluate chosen clinical aspects of acute intoxication with ethanol among patients admitted to the Department of Toxicology from 2002 to 2003. Data of 180 patients with acute ethanol poisoning were analyzed. There were 29 women aged from 15 to 65 (mean 33.9 +/- 15.7) years and 151 men aged from 13 to 75 (mean 39.3 +/- 14.8) years in the group. The alcohol addiction was the most common among men (68.9%), and the people over 30 years old (53.9%). In the adolescents (up to 18 yrs. old) the serum ethanol level was significantly lower but the coma grade was higher then in the adult group. There were 20 patients in deep coma (IV grade according to Matthew scale), 6 of whom (3.3% of the intoxicated persons) had acute respiratory failure with the necessity of invasive mechanical ventilation. There were 95 (52.8%) patients with transient elevation of creatine kinase activity from 191 to 14,616 (mean 1056.4 +/- 2604.3) U/L, and 18 (10%) patients with transient serum creatinine concentration elevation (max. 1.8 mg/dl)., Conclusions: The percentage of the addicted to ethanol were significantly higher among men (male to female 1:8.7), and patients over 30 years old. Despite the significantly lower serum alcohol level in adolescents the grade of coma was higher than in the adult group. There were 6 patients in deep coma and acute respiratory failure who required invasive mechanical ventilation.

The objective of this paper was to evaluate potential beneficial effects of combined treatment with slow-release nitrates and angiotensin converting enzyme inhibitors (ACE) on left ventricular remodeling and exercise capacity in patients after acute myocardial infarction. In this study, 141 patients (aged 34 to 74, mean 56.6 years) with sufficient circulation received combined treatment with 24 hour nitroglycerin infusion followed by oral nitrates (isosorbide mononitrate 50 mg OD) from day 2 day 42 after myocardial infarction and ACE inhibitor (captopril 25 mg BID or enalapril 5 mg BID versus placebo) from day 10 to day 42. On days 10 and 42, echocardiographic examination was carried out and recorded on an optical disc. Simultaneously, on the same days, the treadmill exercise test (modified Bruce protocol) was performed. In the echocardiographic study the left ventricular endodiastolic and endosystolic volumes (biplane Simpson formula), ejection fraction, left ventricular wall motion score and left ventricular mass index were analyzed. Treadmill test criteria, used in the study, included exercise duration time and workload (METS). For each patient the data obtained examination II and I were measured and the differences in their values were classified. The obtained results were analyzed with one-way and three-way ANOVA test. A Kruskal-Wallis test was also used in one variable analysis. Results were analyzed after repartition of patients into groups according type of treatment (angiotensin converting ing enzyme inhibitor or placebo), infarct location (anterior or inferior wall) and enzyme level (CPK < 2000 IU/L or CPK > 2000 IU/L). A p value < 0.1 was considered statistically significant. In a single factor analysis ANOVA proved that the patients treated with nitrates and captopril showed greater improvement in exercise capacity (in METS) than patients treated with enalapril or placebo (+1.26 captopril, +0.2 enalapril and +0.29 placebo, p = 0.043). In addition, a decrease in left ventricular mass index was evident only in patients treated with angiotensin converting enzyme inhibitor (placebo +7.37 gm/m2, captopril -12.17 gm/m2, enalapril -10.14 gm/m2, p = 0.0032). The triple factor analysis ANOVA test revealed that the change in endodiastolic left ventricular volume depends on combination of three factors: infarct location, type of treatment and level of cardiac enzymes (p = 0.009). A decrease in left ventricular endodiastolic volume between day 42 and 10 was observed only in patients with inferior wall infarct and CPK level < 2000 IU/L, irrespective of treatment type and in patients with inferior wall infarct and CPK level > 2000 IU/L treated with angiotensin enzyme inhibitor. We noticed also that heart failure, considered as contraindication to randomization, was in addition the most frequent (up to day 10) cause for study termination and initiation of treatment with angiotensin enzyme inhibitor.

Analysis of biographies of 319 physicians (302 men and 17 women) born from 1880 to 1904, who died from natural causes, was carried out on the basis of annals of medical universities in Poland. Due to small number of women they were excluded from further analysis. There were no statistically significant differences in duration of life between medical scientists- professors, Ph.D. (n = 212, mean = 73.9 +/- 10 yrs) and physicians with the doctor's degree or without any scientific degrees (n = 90, mean = 72.6 +/- 11.4) and among medical scientists working in different fields--basic research (n = 42, mean = 75.1 +/- 9.7), non-invasive disciplines (n = 64, mean = 72.0 +/- 9.9), surgical disciplines (n = 89, mean = 74.4 +/- 11.0), disciplines with limited contact with patients (n = 17, mean = 75.8 +/- 9.0). Average life expectancy at the age of sixty in the whole examined group (16.1 +/- 8.6 yrs) was not statistically different from the general population of men born in the same period (15.1 yrs).