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Buprenorphine is a strong narcotic analgesic. It is also used in the substitution therapy for opium alkaloid addicts. The aim of this paper was to develop and validate a highly sensitive high-performance liquid chromatography-electrospray ionization-mass spectrometry method for simultaneous determination of buprenorphine and norbuprenorphine in human serum. The developed methodology was then applied to real clinical cases in a clinical toxicology setting. Extraction of analytes has been done using solid-phase extraction. Chromatographic separation was achieved on a LiChroCART column with a Purospher RP-18e cartridge, and for detection an LCQ mass spectrometer with an ion trap analyzer was used. Quantitation of buprenorphine and norbuprenorphine was performed in a single ion monitoring mode (m/z 468 buprenorphine, m/z 414 for norbuprenorphine) in order to increase the sensitivity of the method. The standard curves for both compounds were linear over the range of 0.2-10 ng/mL (r2 > 0.995). The quantitation limit was 0.2 ng/mL for both analytes. The method was used for quantitation of both buprenorphine and norbuprenorphine in the serum of 15 patients undergoing the buprenorphine substitution therapy. Serum concentrations ranged between 0.36 and 4.60 ng/mL for buprenorphine and 0.21 and 2.50 ng/mL for norbuprenorphine, with buprenorphine single dosages from 0.8 to 6.0 mg.

The aim was to examine an ability to identify and manage the emotions defined as Emotional Intelligence Quotient (EQ) among benzodiazepine-dependent patients.32 benzodiazepine-dependent patients had been chosen to participate in the study. They were examined by the following EQ measurement surveys: INTE, SIE-T. Personality traits and anxiety levels have been studied using NEO-FFI and State-Trait Anxiety Inventory (STAI).Research points toward EQ decrease among benzodiazepine dependent patients, particularly in face expression recognition ability. Most characteristic results are the neurotic trait (high results), extrovert and scrupulous.Improving abilities enabling proper use of emotional intelligence in problem-solving and effective social functioning is apparently an important component of therapeutic programmes for benzodiazepine dependent patients.

The aim was to examine emotional states among benzodiazepine dependent patients who have been recently successfully detoxified and their coping strategies.32 patients dependent from benzodiazepines had been chosen to participate in the study and they were examined with State-Trait Anxiety Inventory (STAI), The Coping Inventory for Stressful Situations (CISS), The UWIST Mood Adjective Checklist (UMACL).Detoxified benzodiazepine-dependent patients experience symptoms such as: high levels of anxiety (both state and trait), tense arousal, unpleasant mood and low body energy level.In the examined group, the most common coping strategy has been the emotions oriented style which does not affect sources of emotional problems. Presented results point towards necessity of psychological therapy, based around strengthening of coping resources and anxiety removal (relaxation) techniques.

The problem of alcohol and nicotine addiction is both social and medical. The substances are often used together and give complex addiction. The knowledge about mechanisms of complex addiction would be useful for creating effective ways of treatment the abused patients. The aim of the paper was to describe the complex ethanol and nicotine addiction phenomenon. The research was made using data from 30 ethanol and nicotine addicted patients treated in Clinic of Toxicology Jagiellonian University Collegium Medicum in Krakow. 90% of them were nicotine addicted. Tobacco was the first abused substance in the group of patients. The mean period of addiction was 29.0 years for tobacco and 22.2 years for alcohol. The majority of the patients (51.9%) smoked more than 20 cigarettes per day; 29.6% smoked 11-20 cigarettes per day. Single patients were narcotics and drugs addicted. Continuation of the research and toxicological determination of the substances and their metabolites concentrations would be useful for the complex addiction problem explanation and description.

Chronic alcoholism leads to organic damages of nervous system, the liver and the endocrine system. The aim of the study is to evaluate pituitary-gonadal axis in males chronically dependent with alcohol.The study group consisted of 50 alcohol dependent men aged 27 to 53 years (40.7 +/- 6.6) treated at the Ward of Toxicology and Environmental Diseases (Detoxification Unit). Al-cohol dependence was diagnosed according to ICD-10 criteria. The intensity of withdrawal syndrome was measured using CIWA-A scale. In all the patients anthropometrical measurements and abdominal ultrasonography were performed as well as blood pressure was measured. Levels of gonadotropin, total testosteron, PRL were determined, thyroid and adrenal gland function were assessed and oral glucose tolerance test (OGTT) was performed in all patients. Activity of the liver enzymes, urea and creatine concentration were determined. Erectile dysfunction was assessed using IIEF. 5 questionnaire: in those patients who receivedor =21 points an incidence of diabetes mellitus, thyroid gland and cardiovascular diseases was assessed using standardized questionnaire.Alcohol dependency longer than 15 years was stated in 25, longer than 10 years in 9, and longer than 5 years in 16 of examined patients. The moderate withdrawal syndrome was diagnosed in 22, severe withdrawal syndrome in 26 and very severe withdrawal syndrome in 2 of the patients. BMI ranged from 15.8 to 33.8 kg/m2 (mediane 24.67; +/- 0.54 kg/m2). In 24 men erectile dysfunction was diagnosed using IIEF5 questionnaire. No significant difference was noted between level of total testosterone and PRL in the group with or without erectile dysfunction (testosterone: 5.07 +/- 2.41 vs. 4.54 +/- 2.74; PRL: 330.2 +/- 214.2 vs. 307.4 +/- 258.2). Gonadropine level in the group of men with erectile dysfunction was significantly higher than that without erectile dysfunction (LH: 7.4 +/- 5.2 vs. 4.38 +/- 2.23, p0.01; FSH: 13.3 +/- 29.3 vs. 4.59 +/- 19.92, p0.05).The results obtained confirm that secondary stimulation of pituitary-gonadal axis in alcoholic men depends on liver function and ethanol toxic effect on gonads.

The depressant actions of ethanol in the brain is known. SPECT is non invasive method to measure the regional cerebral blood flow (rCBF) and to evaluate indirectly the brain metabolism. The aim of the study is to evaluate morphologic and functional status of CNS using 99mTc-ECD SPECT in chronic alcoholics.Examined group consisted of 18 male alcoholic patients aged from 28 to 52 years (x = 42.1 +/- 5.4) treated at the Ward of Toxicology and Environmental Diseaes (Detoxification Unit). Only patients without prior head injury, CNS inflammatory changes, epilepsy, migraine, diabetes mellitus or other systemic injury were included. Alcohol dependence was diagnosed according to ICD-10 criteria. The intensity of withdrawal syndrome was measured using CIWA-A scale. The regional cerebral blood flow (rCBF) was measured using 99mTc-ECD SPECT with the double head E.CAM Siemens gamma camera. The reference group, necessary to obtain a normal values for the gamma camera applied, consisted of 31 healthy subjects (33.32 +/- 10.99 y).The mean values of rCBF in all examined region of frontal and temporal lobes, and in basal ganglia bothsided were significantly lower in the group of alcoholic patients than in the control group. No significant difference between rCBF in occipital lobes except the occipital inferior region, and in parietal lobes except the parietal superior region. Symetrical hypoperfusion (rCBF-2SD) in the frontal lobes was stated in 11 (61.1%), in temporal lobes in 4 (22.2%), in parietal and occipital lobes in 3 (16.7%) of the patients examined. In 7 the patients examined rCBF disturbances in basal ganglia were found (bothsided in 4, leftsided in 2, and rightsided in 2 the patients). Focal rCBF changes in the parietal, frontal and temporal lobes localised mostly on the left hemisphere were stated in 27.8% of the alcoholics examined. In concusion, the metabolic disturbances and the brain morphological changes mostly in frontal and temporal lobes due to chronic alcoholism were detected in the pilot study. A further investigation on more numerous group of ethanol dependent patients and monitoring of the changes in alcoholics who maintain a long-term abstinence from alcohol is needed.

The aim of the study was to evaluate carbohydrate metabolism in patients hospitalised because of acute intoxication with xenobiotics.An analysis of 3628 patients (1553 females and 2075 males; age: 40.6 +/- 15.9 y) hospitalized at the Ward of Toxicology and Environmental Diseases because of acute poisoning in 2004-2006 was done. The patients with diabetes mellitus diagnosed prior to hospitalisation were excluded from the analysis. The blood ethanol concentration was measured, medication drugs and/or psychoactive substance screening test were performed in all patients on admission. Fasting glucose level on admission and control level on second or third day of hospitalisation were determined. Risk ratio of hyperglycaemia according to toxic agent was assessed using multiple regression model considering age, gender, and the patient education.In 18.2% (398 males and 254 females) of the patients the blood glucose level on admission wasor = 7.8 mmol/l; in u 3.6% (78 males and 50 females)or = 11.1 mmol/l. In 24 (0.6%) of the patients glycaemia on admission wasor = 3.5 mmol/l. Control fasting glucose level ofor = 7.0 mmol/l was determined in 115 males and 76 female patients. 42% elevation in risk of hyperglycaemia was noted in acute carbon monoxide poisoning (OR = 1.42; 95% PU: 1.11-1.82). In ethanol intoxicated patients 12% drop in risk of hyperglycaemia was noted (OR = 0.88; 95% PU: 0.72-1.07). Benzodiazepine poisoning diminished risk of hyperglycaemia in 36% (OR=0.64; 95%PU: 0.48-0.84). Risk of hyperglycaemia in poisoning by medicines co-ingested with ethanol was always lower compared to poisoning with the single agent.A higher risk of hyperglycaemia was related to acute carbon monoxide poisoning whereas lower risk of hyperglycaemia was attributed to benzodiazepines and alcohol. A frequency of hypoglycaemia in the group of poisoned patients was much more lower compared to hyperglycaemia.

The aim of the study was to estimate the risk factors for eventual suicide in the case of individuals hospitalised for a suicide attempts (or attempted suicide). The group examined comprised 238 patients, who, in the years 2000-2001, were hospitalised in the Department of Clinical Toxicology CM UJ in Kraków for suicidal self-intoxication with medical drugs. The group consisted of 63 males and 175 females ranging in age from 17 to 79 years (the mean age was 36 years). The instruments applied in the examination included a structured interview and a set of psychological tests; complementary information was obtained from the patients' case histories. In the year 2005, on the basis of the data from the Institute of Forensic Medicine in Kraków, it was established that 10 of the patients under consideration--6 females, and 4 males--had eventually committed suicide within the period concerned. The retrospective analysis of the case of each of these 10 individuals revealed that the majority of them had been treated psychiatrically for depression or alcoholic addiction, had experienced parental or marital bereavement, or had experienced serious financial difficulties. The subjects' case histories informed also about the cases of suicidal death in the families of several subjects. As should be pointed out, the results of psychological tests obtained earlier by the 10 subjects concerned did not unequivocally indicated high endangerment by the risk of eventually committing suicide. Finally, it is necessary to observe that alcoholism and depression were the most frequently diagnosed mental disorders in the case of the male suicides. In the case of the female suicides, the results of the analysis reveal a variety of psychological, psychiatric and socio-demographic factors that, eventually, could lead to suicide.

The study was aimed at a preliminary evaluation of the effect of buprenorphine, a synthetic opioid used as a substitute in the therapy of dependence on psychoactive substances, on the structure of the genetic material of patients receiving such treatment. The material for the study were lymphocyte cultures from peripheral blood, analysed by a cytogenetic micronuclear test. The obtained results were compared with the literature data on the mutagenic action of methadone.

The aim of the presented study was the assessment some socio-demographic factors of alcohol dependent patients more times hospitalized in Department of Toxicology in Kraków in the years 1999-2004. The repeatedly hospitalization of 334 patients (298 men and 36 women), aged from 17 to 71 years (mean 45.1 years) due the alcohol problem on the basis of clinic documentation were established. The following socio-demographics traits were taken in analysis: age, sex, marital status, place of living, education, kind of jobs, employment and others sources of money. The patients were admitted from 2 or more 29 times during 6 years. Medical history of addiction of mentioned patients was from 1 to 40 years, mean 25 years. 43.7% persons live single and 53.6% was married. The most patients live in Kraków (80%) and others near the town. The education of them: 15.0% ended high school, 28.7% "medium", 30.5% "low professional" and elementary school--13.8% of them. This factor was similar like regional data. Amount mentioned persons 25.8% worked for salary, 11.7% had own business, and 25.4% was retired, and 29.0% was unemployed. This last factor was worse liked similar from mentioned region. The kind of jobs of persons on the aspect of "social safety" was described. Among the mentioned chronic alcohol addicted persons about 18.8% of them with machines in traffic was worked (bus drivers i.e.) and 7.5% described persons in special jobs was worked (policemen, physician i.e.). The authors were suggested that mentioned factors due health services cost in Poland and propose integration of treatment of alcohol-addicted patients.

As a somatic evaluation by outpatient psychotherapy service for alcoholics is being done very rarely the patients are not informed about health harm related to alcohol having the "false feeling of safety". The aim of the study was to evaluate a functional and morphological liver state of patients served by such a service for minimum 5 years who were sent do the Department of Clinical Toxicology via intervention medicine. The changes in the central nervous system were also considered. The West Haven criteria of altered mental state in hepatic encephalopathy were applied. The Number Connection Test, part A and B, and "100-7" test were used to psychometric evaluation. A significantly higher serum ammonia concentration (p0.02), AST, ALT and GTP enzymes activity, bilirubin (p0.02), iron (p=0.005) concentration and significantly lower prothrombin index and albumin concentration were found in the group of ethanol dependent patients as compared to the reference group. A significantly lower RBC and platelets number, lower Ht and significantly elevated MCV compared to the control group were also found. The relationship between West Haven criteria and results of laboratory testing was shown: a worse West Haven criteria a worse metabolic disorders. The pathologic changes in the liver ultrasonography and scintigraphy were significantly higher in the group of ethanol dependent patients. The presented observations indicate on necessity of close co-operation between psychologists, therapeutics and clinical toxicologists in early diagnosing and treatment the organ injury in alcohol addicted patients.

The aim of the presented study was the assessment of somatic and psychiatric disorders in alcohol addicted patients, treated in the Department of Clinical Toxicology detoxification unit in Kraków in 2002 year. The total number of 443 patients (377 men and 66 women) were considered for the research. More than 50% patients were hospitalized repeatedly (2 or more times) due to alcohol problems. Medical history as well as detail medical examination and diagnostic evaluation revealed the concomitance with alcohol disease different somatic illnesses and psychiatric disorders. In 194 patients (43.8%) the alcoholic liver damage was diagnosed, frequently (in 5.2% patients) with chronic pancreatitis. Only 22 patients (5%) were infected with hepatitis virus type B. Diabetes type 2 and different cardiovascular disorders were present in almost one third of patients. In the past 55 patients (12.4%) have had severe head trauma, and 51 (11.3%) were treated because multiorgan trauma. Psychiatric examination revealed in 102 patients (23%) affective disorders, and in 92 (20.7%) personality disturbances. The presented data should be a ground for discussion about treatment model alcohol dependency in Poland.

There are many studies on problems related to alcohol abuse in many aspects from many countries. As a preventive strategy a few years duration programs for numerous populations are being conducted for tightening of social interrelation, to prevent juvenile drinking, to avoid drinking and driving etc. USA study on drinking and driving people indicate on different psychiatric disorders and needs for deeper psychiatric insight. Analysis of different source information on alcohol related traffic collisions is a basis for prevention strategy programs. Our study may contribute in small number of psychology publications related to psychometric testing on motor skills, cognition ability and social condition of people who drive and drink. There were 50 ethanol dependent patients treated at the Department of Clinical Toxicology detoxification unit. All of them had a driving license; majority had access and opportunity to drive a car. A structured interview and psychometric tests were used to evaluate psychology functioning. It can be assumed that deficits revealed in the examination may be detrimental factors to proper and efficient driving ability.

The aim of the study was a preliminary recognition of genotoxic effect of methadone, using a culture of lymphocytes obtained from the blood of 23 opiate dependent patients from methadone maintenance treatment programme conducted at the Department of Clinical Toxicology of Jagiellonian University Medical College. The micronuclei (MN) occurrence and the number of sister chromatids exchange in methaphasal plate were the examined markers of mutagenesis. Two control groups differently exposed to environmental mutagenic factors were used to verification of results. The increased fraction of cells with the high number of sister chromatids exchange (HFC) indicate on possible genotoxic effect of methadone, however in the populations exposed also to other mutagenic factors the effect is not so evident.

Methadone treatment programme for 50 opiate addicts has been conducted at the Department of Clinical Toxicology for a one year. The aim of the study was to evaluate the health state including psychological condition and also a social status of the opiate dependent patients after one year methadone maintenance medication. Also, considering the results of clinical examination, a trial of elaboration of system for dependence scoring was undertaken. An improvement of general health state of addicts was observed. No new cases of HIV positive patients were noted. An increase in number of addicts who start professional activity, and those who live in procreative families and even in formally confirmed marriage. A three pregnant women, and five who already gave birth to a child (one of them is completely drug free at present) were noted. A significant behavioural changes, reduced level of criminal activity and restored personal relationships with family were observed. A moderate psychopathological symptoms are still observed in patients with double diagnosis.

An diagnosing of ethanol dependence, despite of clear ICD 10 criteria, in patients treated particularly at the toxicological and detoxication wards, but also in other hospital wards is still a difficult task. Several questionnaires have been developed for easier detection of symptoms, the way of drinking and also for economic, family and medical effects of ethanol drinking in examined patients. A high sensitivity and specificity of CAGE and SAAST questionnaires allowing to identify problem drinkers or alcohol dependence in 192 patients of Kraków Department of Toxicology and 475 patients of Detoxification Unit was stated in the study. The CAGE questionnaire has allowed to identify the possibly ethanol dependence in group of 74 patients hospitalized at the Ward of Internal Diseases and Dialysis of Town Hospital in Sieradz, because of illness, that were not connected with alcohol drinking.

Methadone maintenance programs have effectively reduced opiate dependency and are available in many countries, also in Poland. In Kraków 50 persons were qualified to methadone maintenance treatment. Their age varied from 21 to 46 years, mean 27.8 years. Participants of the programme were mainly educated on basic technical level, unemployed, after 3 to 30 attempts of detoxification treatment. After initial observation at the Detoxification Unit of the Department of Clinical Toxicology and establishing effective daily oral dose of methadone, all patients in Outpatient Clinic of Abuse receive daily adequate dose of methadone, where in parallel, individual and group psychotherapy is used. Methadone programme which was applied seems to prove the fact, that it can significantly improve life quality of addicted patients as well as increase the level of public safety.

The pattern of adolescent and adult poisonings in Kraków is presented on the basis of the data collected by the Poison Information Centre of the Department of Clinical Toxicology Collegium Medicum of the Jagiellonian University in 1997. This analysis includes 3472 people treated at the Department of Clinical Toxicology and 118 poisoned people who were not given any treatment and died at the scene of the accident. The group of hospitalised persons consisted of 2359 (67.9%) men and 1113 (32.1%) women, and the group of people who died at the scene of the accident consisted of 97 (82.2%) men and of 21 (17.8%) women. The overall coefficient of poisonings in 1997 was 46.9; for men--67.8 and 28.3 for women. Ethanol (39.7%) followed by drugs (20.2%), drugs + ethanol (6.7%), carbon monoxide (6.2%) and drugs of abuse (4.4%) were the most common cause of acute poisonings. The mortality rate of the cases treated was low (0.43%), but while including those people who were not given any treatment and died at the scene of the accident, mostly due to ethanol, carbon monoxide, and drugs poisoning the fatality index rose up to 3.7%.

Intoxication with many xenobiotics cause serious electrolyte abnormalities which require intravenous supplementation. In chronic and acute but not very severe intoxication an oral supplementation of ions can be sufficient. The aim of the study was to evaluate the usefulness of Aspargin for supplementation of potassium and magnesium in chronic alcoholics suffering from withdrawal syndrome. There were 46 study patients, dependent on ethanol treated at the Detoxification Unit of the Department of Clinical Toxicology in Krak w. A differently intensified symptoms of ethanol withdrawal syndrome were noted according to CIWA-A scale in all the patients. Concentration of potassium and magnesium was monitored through the hospitalisation. Except a basic treatment (fluid supplementation, benzodiazepines) also Aspargin (three times a 2 tablets per day) was administered to each of patient for 7 to 10 days. No respiratory, muscular and gastrointestinal symptoms due to hypopotassemia and hypomagnesemia have been noted while hospitalisation in any patient so it could be suspected, that oral supplementation with Aspargin was sufficient to keep these ions balanced. Administration of Aspargin was beneficial to patient and the treatment outcome.

The goal of this study is to evaluate the number and the reasons (poison and structure) of acute poisonings which occurred among Kraków adult inhabitants in the year 1995. Under analysis there were 3003 people treated at the Department of Clinical Toxicology and 210 poisoned who died at the place of accident prior to any treatment was conducted. The group of hospitalized persons consisted of 63.7% men and 36.3% women, and the group of people who died at the place of accident consisted of 89.5% men and of 10.5% women. The overall coefficient of poisonings during the year 1995 was 48.3; for men was 66.7 and 32.5 for women. A drugs (45.1%) followed by ethanol (42.8%) were the most common cause of acute poisonings. The mortality rate of the treated patients was low (0.7%), but while including those people who died at the place of accident prior to any treatment, the mortality rate rose up to 7.2%. That increase in the mortality rate was caused mainly by fatal cases due to ethanol and carbon monoxide poisonings.

The aim of the study was to evaluate the number and the course of acute pesticides poisoning treated in the Department of Clinical Toxicology in 1986-1995. During that period 264 cases (189 men and 75 women) of acute pesticides poisoning were treated. Suicidal oral ingestion followed by inhalation and dermal exposure was the most common cause of acute intoxication. Organophosphates and carbamates were the most common cause of acute intoxication. Poisonings with dipyridyls and sulfonylurea derivatives are relatively rare. The highest number of poisonings was noted in age group 30-39 years. In 37% of the total analysed cases the co-ingestion of ethanol was noted. As organophosphorous compounds were the most common cause of acute pesticides poisoning, the gastric lavage + intensive care treatment + specific and non-specific antidotes were the most common therapeutic management. Duration of hospitalisation was dependent on the kind of pesticide. The longest hospitalisation required the patients poisoned with organophosphates. A full recovery was noted in 57.6% of poisoned patients. 34.1% of patients suffered different organ injury mostly from respiratory and central nervous system. 22 (8.3%) the fatal cases were noted in analysed period.

In the paper a thorough study of the influence of the methemoglobin levels and the occurrence of certain syndromes of clinical symptoms was made in the inhabitants living in the immediate vicinity of the large refuse dumps. During a 2.5-day clinical hospitalization the following examinations were done: general medical, specialistic and neuropsychological examinations, biochemical-analytical examination, EKG, chest X-ray, USG of the abdominal cave, spirometric tests, toxicological investigation of body fluids: carboxyhemoglobin, methemoglobin, lactates. The air pollution was measured and included: continuous measurement of the suspended particulate matter, carbon monoxide, sulfur dioxide, nitrogen oxide, nitrogen dioxide and the sum of nitrogen oxides. The evaluation of the refuse dumps gas showed that its main compounds were: carbon dioxide, methane in the amount of a few volume percent. Other pollutants were: carbon monoxide, hydrogen sulfide, methane homologues and aromatic hydrocarbons. The results of biochemical investigations were within normal limit. The elevated methemoglobin levels were found in 8 patients. The increased values of blood lactate concentration were found in 14 people and in 8 people the elevation of carboxyhemoglobin level was noted. The results of toxicological investigation do not unequivocally indicate the occurrence of toxic methemoglobinemia. However, the elevated levels of methemoglobin and lactates indicate a slight degree of oxygen deficiency in the body. In the examined people typical symptoms of methemoglobinemia were not observed, the only symptoms which may indicate their impact on the central nervous system were frequent headaches and neurovegetative disorders.

The aim of this study is to compare the frequency, kind and structure of acute poisonings of the Kraków residents in years 1983 and 1993. The group of 2132 people treated for acute poisonings in the year of 1983 consisted of 50.6% men and 49.4% women, in 1993 the group of 2311 patients consisted of 60.7% men and 39.3% women. The group of 154 poisoned who died at the place of accident in 1983 consisted of 89.6% men and 10.4% women, whereas in 1993 the group of 220 such cases included 83% men and 17% women. The overall coefficient of poisonings during the years compared was 36.2 for 1983 and 42.0 for 1993. The coefficient of poisonings in the years examined of 1983, 1993 were 39.4 and 50.4 for men, and respectively 33.4 and 28.0 for women. In 1983 the poisonings with drugs (40.6%) were most numerous, ethanol came second (25%). In 1993 the first place took ethanol (31.8%), the second drugs (31.3%). The number of poisonings with carbon monoxide increased from 9.87% in 1983 to 13.6% in 1993. The comparison of numbers concerning the mortality rate of the treated patients and of those who died at the place of accident prior to any treatment, shows a considerable growth in mortality rate in 1983 from 1.1% up to 7.8% and in 1993 from 0.8% to 9.4%. Such a significant growth in this mortality rate is influenced by poisoning with ethanol and carbon monoxide at the place of accident.

Three cases of poisoning with oral red lead are presented. All 3 young persons ingested red lead for suicidal purposes. Six months prior to this poisoning all of the underwent detailed, medical examinations which did not reveal any pathologies. Toxicological analysis of the body fluids has shown the following results of urinalysis: lead (Pb) 2.41-9.29 mg/L; delta-aminolevulinic acid (ALA) 1.7-2.7 mg%; coproporphyrin-0.033-0.11 mg/L. Central nervous system activity has been assessed with the aid of a complex psychiatric examination, psychological tests, EEG, and CT-scans of the head. Organic lesions to CNS have been diagnosed in all poisoned patients. All of them were re-examined 4 months and 3 years after poisoning. This has enabled dynamic evaluation of remote CNS damage.

Zinc vapour poisoning by inhalation in the form of zinc fever is more frequent than oral zinc product poisoning, the product used in therapy. The main aim of the study was the evaluation of clinical manifestation present after Zincteral ingestion as well as attempt to find the relationship between the presence and aggravation of the clinical manifestation and zinc level in the blood. The course of acute clinical suicidal poisoning by ingestion of Zincteral 50 tablets (10.0 g) and 100 tablets (20.0 g) is presented. The clinical picture revealed the following symptoms and signs: tachycardia, changes of arterial BP, vascular shock; dyspeptic nausea, vomiting cramps in abdominal region, diarrhoea. Damage of the parenchymatous organs, mainly liver was evident. In pregnant woman (9-week-pregnancy) on the 12-th day of her stay in the Clinic complete miscarriage took place accompanied by haemorrhage from reproductive organs. The kind and exacerbation of the clinical manifestations in relation to the zinc level in body fluid were analysed.

In Kraków in 1983-1987 11,664 cases of acute poisoning by chemical substances were reported: 11,123 patients were hospitalized; 541 patients died before was given any medical intervention. Among those patients who were treated there were 9725 adult patients older than 14 years--hospitalized in Toxicological Department and 1398 children who were treated in the pediatric departments of many hospitals in Kraków. The cases of the poisoning due to suicidal attempt in the studied period mean 43% and during this time the decreasing tendency was evident (from 47.6% in 1983 to 34.4% in 1987). Narcotic and drug addicts covered only 2% of the whole material concerning the cases of the acute poisoning. Overall incidence rate of poisoning by chemical substances per 10,000 inhabitants of Kraków ranged from 33.9 in 1983 to 32.7 in 1987, and it was always higher in adult population (32.6 in 1983-35.0 in 1987) than in children (24.5 in 1983-23.4 in 1987). During the whole studied period and its successive years the most common poisoning was the poisoning due to: drugs (mean 50%), ethyl alcohol (mean 22%), and carbon monoxide (mean 18%). The highest incidence rate of the acute poisoning was presented to the hospital or clinic in January and October; on Mondays, Tuesdays, and Thursdays; between 12 p.m. and 12 a.m., whereas the lowest was noted during summer months; on Sunday; between 4 a.m. and 8 a.m. Our studies gave us a real picture of the poisons the population in Kraków is exposed to; and total mortality rate amounts 0.8%, yet being calculated on the base of clinical studies goes up to 5.4% when forensic data are taken into account.

Acute poisoning by carbon monoxide (CO) in Kraków takes the third place after drug and alcohol poisoning. When natural gas came into use, the incidence of acute CO poisoning decreased profoundly. But mortality rate of this poisoning can still tell how severe it is. The authors presented the relation between the incidence rate, complications and mortality rate of CO poisoning and the source of this gas emission. 243 subjects were treated in the intensive Toxicological Care Unit from 1966 to 1985, and during the first 10 years lighting gas was the main cause of the poisoning but during the second the poisoning was mainly caused by CO produced by incomplete combustion of some components of natural gas. This 20-year period was characterized by routine treatment. The change of CO emission source introduced in 1976 had not radical statistical influence on the clinical picture, complications, mortality of CO poisoning.