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Unlabelled: 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., Material and Methods: 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 received < or =21 points an incidence of diabetes mellitus, thyroid gland and cardiovascular diseases was assessed using standardized questionnaire., Results: 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, p < 0.01; FSH: 13.3 +/- 29.3 vs. 4.59 +/- 19.92, p < 0.05)., Conclusion: The results obtained confirm that secondary stimulation of pituitary-gonadal axis in alcoholic men depends on liver function and ethanol toxic effect on gonads.

An analysis of patients with mushroom poisoning hospitalized in the Clinic of Toxicology in Cracow revealed that only a small percentage of cases had been caused by the death cap Amanita phalloides (Vaill. ex Fr.) Secr. The most important factors contributing to intoxication are confusion of toxic mushrooms with edible species, and non-specific mushroom poisoning. The genus Amanita has a global distribution and is one of the most well-known genera of macrofungi. Active toxins present in the panther cap (A. pantherina) (DC ex Fr.) Secr are ibotenic acid and muscimol, which are rapidly absorbed from the gastrointestinal tract. It is likely that other substances also participate in the psychotropic effects. Five frayed panther cap fruiting bodies were eaten by mistake by two persons (27 and 47 years of age). Symptoms onset occurred after 120 min with central nervous system (CNS) depression, ataxia, waxing and waning obtundation, religious hallucinations and hyperkinetic behaviour. In the present case, successful general symptomatic treatment was administered, which consisted of controlling the nervous symptoms and stabilizing the electrolyte balance. The poisoning regressed with no organ complications.

Chloroquine is a derivative of 4-aminoquinoline, which is used in the malaria prophylaxis and treatment and the therapy of some connective tissue diseases. Its narrow therapeutic index causes that the medicine is relatively toxic, especially in the case of an overdose or an acute intoxication. In the recent study two cases of the acute chloroquine poisoning, hospitalized in the Toxicology Department in Kraków, were described and one of them was fatal. The first case was 16-year-old girl who ingested 5 g of chloroquine phosphate in the suicidal attempt. After about 2 hours general seizures appeared followed by ventricular fibrillation and cardiac arrest. After near 2-hour-lasted reanimation procedures she was resuscitated, but 14 hours later another cardiac arrest appeared because of the bradyasystole. Despite the institution of advanced reanimation methods including external pacemaker and electrostimulation, spontaneous circulation did not return and the patient was declared dead. Postmortem toxicological examination of blood, vitreous humour, bile and liver revealed extremely high concentrations of chloroquine (252.15 mg/l in blood). The second case was the 15-year-old girl who ingested 7.5 g of chloroquine phosphate. She developed significant hypotension requiring intravenous infusions of fluids and catecholamines and respiratory distress positively treated with endotracheal intubation and mechanical ventilation. In both cases a considerable hypokalemia and prolonged QTc interval were observed. According to the literature, a clinical picture, diagnosis and recommended therapy of an acute chloroquine poisoning were reviewed.

The aim of this study is the presentation of the case of acute methanol inhalation poisoning and CSN damage connected with this incidence. 23-years old male patient addicted to organic solvents for 5 years was admitted to the Toxicological Unit because of suspicion of organic solvents poisoning. In the case history the patient was exposed to organic solvents in the admission day, he denied drinking alcohol in last time. Phenol and TCA were not confirmed in the toxicological urine analysis. Because of marked metabolic acidosis which was present in the moment of admission subsequental toxicological investigations were conducted. The 0.23 g/l of methanol in blood was revealed. The vision loss was observed in the first day of hospitalization, up to total blind in the third day. Signs of toxic optic nerves neuropathy was revealed in ophthalmological examination. Brain perfusion disturbances in frontal and basal ganglia region was found in the brain perfusion scintigraphy examination. In the 6 month follow up outpatient observation, the partial vision recover was noted. The normalisation of frontal brain perfusion in the perfusion scintigraphy was found. Until now, there is no explanation the route of methanol intoxication--it could be suspect, that the solvents inhaled by patient were contaminated with methyl alcohol.

On the 21st of August 1997 the Polish legislature introduced the first animal protection law nr 724. This act however failed to specify in a clear and proper manner the problem of possession and maintenance of dangerous animals, which allows its multiple interpretations. Poland ratified the Washington Convention in 1990 restricting the trade of animals classified as endangered species. The present regulations enable illegal purchase and trade of those animals. According to the available data illegal trade of such animals, as well as the trade of products obtained from them, ranks in the third position in terms of crime generated income, only after the trade of drugs and weapons. In our country the sales of such animals have been growing at an alarming rate. The animals often get out of the control of their owners, or are abandoned by them. The presented work describes cases of reptiles being found in public places in our region. It also mentions the problem of possible dangers associated with intentional letting out of such animals in public places. The aim of the following paper is the analysis of the problem of raising of exotic animals, in particular venomous snakes and other animals, the possession of which may be dangerous not only for the owner but also for the people around. The existing laws and executive procedures have been discussed. Both, the family doctors as well as toxicologists have little knowledge as far as diagnosis and treatment of cases of stinging and biting by exotic animals is concerned. The authors suggest providing medical emergency doctors, family doctors and surgeons, with clinic toxicology programs, as well as introduction of special courses for middle medical personnel. Establishment of a central database and a database concerned with basic polyvalent serums are crucial in our country in order have the Toxicology Centers ready to face possible dangers associated with dangerous animals, and to prepare emergency solutions in cases of criminal actions involving the use of dangerous animals.

In our previous study a tetraethyl lead poisoning due to a rural environmental exposure of four family members was described. A differently intensified OUN dysfunction dominated clinical picture. Cognition status and degree of OUN dysfunction was monitored using generally accepted neurobehavioral test battery. The tests applied were fitted individually to each poisoned family member in accordance to current intensification of symptoms. Basing on the neurobehavioral performance results a consecutive imagine techniques were introduced to full CNS evaluation of intoxicated patients. Results of neuropsychological monitoring in 12 months period were compared to brain CT, SPET 99mTc-ECD used to evaluation of regional brain perfusion disturbances, MRI and MRS and presented in the study.

Unlabelled: The aim of this study was the presentation of the chronic tetraethyl lead poisoning of the 4 person family in the place of settlement., Case Report: 15.5-years-old man was admitted to the regional Pediatric Ward because of changes of behavior, hallucinations, agitation. Nausea, vomiting, metallic taste and diarrhea were observed prior to the admission. In the case history, there were no data suggested of the toxic origin of the disorder . The CSF examination and CT of the brain were normal. Increased activity of CPK, ALT, AST, GTP, LDH in the blood were found. Paranoid syndrome was diagnosed by psychiatric evaluation. The patients' mother presented similar signs in almost the same time. The laboratory tests of the blood taken from the patients' father and older brother revealed the increase activity of the same enzymes (CPK, ALT, AST, LDH). All family was admitted to the Department of Clinical Toxicology in Kraków because of suspicion of the heavy metal poisoning. The toxicological laboratory test showed in all described patients the toxic serum lead concentration accordingly: 440 microg/l--older brother, 490 microg/l--father, 508 microg/l--mother and 635 microg/l--primary described patient. Because of the fact, that were no characteristic for lead poisoning changes in blood picture, the toxicological investigations were continued. As a result of these examinations presence of a diethyl lead in urine was confirmed. In the evaluation of the multiorgan damages connected with tetraethyl lead poisoning, we paid special attention on CSN dysfunctions. The USG and scintigraphy examinations revealed the liver damage. The different kinds of arrhythmias indicated on cardiovascular system damage. Based on clinical presentation and laboratory investigations the chronic tetraethyl lead poisoning was diagnosed.

The double tracer (99mTc-MIBI and 99mTc-Amiscan) scintigraphy is an useful technique to imagine cardiac injury due to CO intoxication. Accumulation (retention) of 99mTc-MIBI is dependent on blood flow and cellular and mitochondrial electrical potential of myocytes. The lower tracer accumulation is seen not only in necrotic heart tissue regions, but also in ischemic area of worse metabolic rate and perfusion. 99mTc-Amiscan contrary to 99mTc-MIBI, is accumulated only in regions of early necrosis so it can be can distinguished from transitory ischemia. Mechanisms of cardiac injury due to CO toxicity is different than due to coronary occlusion and the process of the heart damage is usually much longer. Results of control stress-rest 99mTcMIBI scintigraphy, performed after 6 months from CO exposure in relation to the clinical state on admission and results of 99mTc-MIBI and 99mTc-Amiscans scans obtained in acute phase of poisoning are presented in the study. Initial 99mTc-MIBI SPET examination had confirmed transitory myocardial ischemia of different degree in all the examined patients. The mutual dependence between degree of scintigraphic changes and blood lactate level and CK activity was found. 99mTc-Amiscan scintigraphy demonstrated areas of necrosis in myocardium of some patients; they had statistically higher COHb and blood lactate concentration compared to the rest. A control stress-rest 99mTc-MIBI SPET performed 6 months after CO intoxication, confirmed a late consequences of metabolic abnormalities and a necessity of cardiovascular system follow-up controlling.

The results of myocardial (99mTc-MIBI SPECT) perfusion scintigraphy according to clinical evaluation, ECG, biochemical factors of necrosis and indicators of carbon monoxide (CO) poisoning severity are described in the paper. Under examination there were 88 young (mean age 26 +/- 8.5) acutely CO poisoned patients without previous cardiac illness history, treated at the Department of Clinical Toxicology Jagiellonian University Medical College in Krakow in 1996 to 2002. Measurement of COHb level, blood lactate concentration, duration of exposure and ECG examination were performed on admission. The enzymes activity ALT, AST, CK, MB-CK, was evaluated after 24-48 h. The severity of CO poisoning was estimated basing on age, duration of exposure, COHb level, blood lactate concentration and the patient neurological state on admission. 99mTc-MIBI SPECT was performed on days 1 to 5 post admission. The abnormalities in scintigraphic scans were assessed according to arbitrary accepted scale (0-IV). Conventional biomarkers creatine kinase, ALT and AST were insufficient for evaluation the heart injury in CO cutely poisoned patients. A statistically significant differences in the blood lactate concentration with regard to degree of scintigraphic changes have been observed. The ECG curves monitored from admission to discharge were analyzed in the study. Tachycardia was observed in all the patients but no statistically significant differences were found between the subgroups divided according to the degree of scintigraphic scans. Conductivity disturbances were detected mainly in patients qualified to higher then the first degree of scintigraphic changes. ECG signs of myocardial ischemia were the most frequent in patients with biggest pathological changes in 99mTc-MIBI scans. The changes in 99mTc-MIBI SPECT were observed in the majority of acutely CO poisoned patients. The mutual dependence of patient's condition based on neurological symptoms, carbon monoxide poisoning severity scoring and the degree of scintigraphy changes was found. The examination performed indicate that 99mTc-MIBI SPECT scintigraphy can be method of choice for evaluation the heart injury in patients after acute CO intoxication.

The presence of volatile compounds, such as acetone, acetaldehyde, methanol, ethanol, isopropanol, and n-propanol, in the blood of 169 acutely poisoned alcoholics was determined. The clinical diagnosis of addiction was made on the basis of a patient interview as well as physical, psychological, and psychiatric examination. At the time of the patients' admission to the clinic, the mean concentration of ethanol in blood was 3.14 +/- 1.10 g/l and its elimination rate in the studied group was 0.27 +/- 0.08 g/kg/hr, an elimination rate significantly higher (P <.001) than that of social drinkers, which averages to 0.014 +/- 0.04 g/kg/h. The presence of other volatile compounds in the blood of alcohol-addicted patients is common. The calculated elimination rate constant of methanol was about 0.2 h(-1). This rate seems to indicate that, in heavy drinkers, the elimination of methanol may be relatively fast even if the ethanol concentration is above 1 g/l. The elimination of other volatile compounds can be accelerated by large doses of ethanol, although it is not correlated with actual blood ethanol level. Moreover, in most of the blood samples with a methanol concentration below 10 mg/l, the measured concentration of acetone was below 7 mg/l and that of isopropanol was below 2 mg/l.

Guillain-Barré Syndrome is the most common form of polineuropathy. It is suggested that some infectious, immune and allergic factors are involved in developing the syndrome. "Kompot" or "Polish heroine", a domestic product, is produced from poppy straw or juice of poppy head (Papaver somniferum) and it is administered intravenously. "Kompot" shows variable contents of heroine, 6-MAM, 3-MAM, morphine, acetylo-codeine and codeine as well as papaverine, thebaine and narcotine. The case history of a young man dependent on "Polish heroine" who developed the Guillain-Barré Syndrome due to severe intoxication induced by home made heroine, barbiturates and benzodiazepines is described.

In the last ten years advances in analytical methods have enabled the determination of xenobiotics in alternative material such as sweat, saliva, and hair. The aim of this study was to develop an analytical method and measure the concentration of the main opiates in serum saliva and hair of subjects from a detoxification and methadone treatment programme. The analytical strategy in the presented study, based on enzymoimmunoassay screening of opiates in urine and GC/MS confirmation, meets the needs of forensic and clinical toxicology. Blood and saliva samples from thirty seven patients and hair from twenty three with a history of intravenous opiate use were collected for analysis. The ranges of morphine in serum and saliva were 0-2081 and 0-208 ng/ml respectively; corresponding concentrations of codeine were 0-580 and 0-428 ng/ml respectively. The concentration of morphine, codeine and 6-MAM in hair of addicts ranged respectively from 0-32.4, 0-12.5 and 0-2.8 ng/mg. From the clinical toxicology point of view, hair analysis is supplementary to urine, serum or saliva determination, but in drug testing at the workplace it can play a crucial role.

Although it is known that drug addicts are a high-risk group for disruption of many homeostatic processes, little is know about changes in serum trace elements concentrations after taking the psychoactive substances. The aim of the study was to check the influence of the taking homemade heroin on serum level of copper. Blood samples were taken from 30 opiate addicts, and copper concentrations were measured by the means of atomic absorption spectrophotometry. The result of the study show that in the examined group, copper serum concentrations (1.35 mg/L) upon admission to the clinic were higher than in the control group (1.11 mg/L) but decreased during hospitalization (1.18 mg/L). There was no correlation between duration of stay at the hospital and changes in serum copper concentration.

The aim of this study was to determine the concentration of zinc, copper and magnesium in the blood serum of drug addicts in order to ascertain whether drug abuse has an effect on the concentration of these metals. The study was carried out on a group of 33 addicts undergoing treatment at the Department of Clinical Toxicology, Collegium Medicum, Jagiellonian University in Kraków. The control group consisted of 22 young, healthy, drug free, male volunteers. Analyses were performed using flame atomic absorption spectrometry. The results demonstrate that zinc serum concentrations in the examined group of addicts before therapy (mean 0.82 mg/l) were reduced in relation to the control group (mean 1.12 mg/l), and was slightly enhanced after the detoxification process (mean 0.86 mg/l). The opposite effect was observed in the case copper serum concentration. The copper level in the group of addicts on admission to hospital (mean 1.35 mg/l) increased in relation to the control group (mean 1.11 mg/l) and was lower during hospitalisation (mean 1.18 mg/l). The concentration of magnesium in the serum of drug addicts did not change during therapy and was in the same range as in the control group (mean concentrations were 20.3 mg/l, 20.2 mg/l and 20.6 mg/l respectively).

The aim of the study was to evaluate the frequency and the kind of multiorgan damage in acute oral carbamates poisonings. Under analysis there were 36 carbamates orally poisoned patients treated at the Department of Clinical Toxicology in the years 1987-1997. Patients with the liver or biliary tract diseases, chronic circulatory insufficiency symptoms, HBs antigen carriers, who suffered head traumas, CNS illness and heavy drinkers were excluded from the study. The organs damage was noted in 91.7% of the poisoned patients. The respiratory system followed by the CNS and the liver were mostly affected by carbamates toxicity. The frequency of pathological changes in the kidney and circulatory system was relatively lower. Only in a few persons peripheral nervous system injuries were noted. In 15% of the examined group the injuries of one organ only was stated. In 48.5% of the patients simultaneous injury of two and three organs or systems were noted. 36.3% of the patients suffered from multiorgan (four or more) damage. In all the severely poisoned patients (III degree) the organs damage was noted. In 53% of them the simultaneous damage of four or more organs/systems was noted. In the group of patients stated as moderately poisoned on admission to the clinic, the multiorgan damage (2-3 organs/systems) was found in 77% of the patients. The lowest number of organ damage was observed in the group of slightly poisoned patients.

The aim of this study was to evaluate a morphological and functional status of the CNS in acute cholinesterase inhibitors (ChI) poisonings using the brain computer tomography (CT) and complex psychiatric examination. Under examination there were 59 cholinesterase inhibitors orally poisoned patients, treated at the Department of Clinical Toxicology in years 1984-1997, aged from 14 to 68 (mean 34.7 +/- 12.8) years. The examined group comprised 9 women (15.3%) and 50 men (84.7%). Between the 3rd and 7th day of hospitalisation a complex psychiatric examination was performed. The CNS damage was diagnosed when the point score from complex psychiatric examination was minimum 5 points. CT was performed between the 3rd and 10th day after the intoxication. Incorrect CT scans were found in 78% of poisoned patients. The most common lesion was generalised cortex atrophy and subcortex atrophy of the brain (73.9%), followed by isolated cortex (17.4%) and subcortex atrophy with simultaneous areas of low density in the subcortical nuclei (8.7%). The frequency of incorrect CT scans was statistically higher (p < 0.01) in the group of organophosphorous compounds poisoned patients compared to those poisoned with carbamates. The complex psychiatric examination revealed in 24 patients (40.7%) the differently intensified alterations, but the point score was not higher than 4. Unquestionable damage of the CNS was recognised in 34 patients (57.6%) of the ChI poisoned patients. The frequency of CNS changes detected in complex psychiatric examination was statistically higher (p < 0.01) in the group of the severely poisoned patients. The significantly higher frequency of pathological changes revealed by the brain CT was found in the group of patients with higher than 5 point score obtained from the complex psychiatric evaluation compared to those with score lower than 5 (p < 0.001).

An analysis of ethylene glycol acute intoxication treatment results was performed in a group of 36 patients hospitalized within a five year period. Mean serum and urine glycol concentrations in the analyzed population ranged from 0-851 mg/dl (mean = 130 mg/dl) and from 12.4 to 930.0 mg/dl (mean 333 mg/dl), respectively. At the time of admission to the clinic 15 of 36 patients were deeply unconscious and mean acid-base balance values were as follows: pH 6.99, pCO2 16.7 mmHg, pO2 140.1 mmHg, HCO3 6.36 mmol/l, BE -29.6 mmol/l. Because of respiratory failure 21/36 patients (58.3%) required controlled ventilation and 24/36 (66.7%) underwent dialysis. Sixteen patients (44.4%) developed acute renal failure. Mean hospitalization period was 16 days (1-53). Eighteen patients (50%) died. The direct death mechanism in 15 patients (83.3%) was asystolia and in the remaining individuals other circulatory disturbances. The main reasons of high mortality rate were multiple organ damages secondary to severe metabolic acidosis.

Problems with the assessment of organ damage caused by toxic substances in places of residence have recently appeared with increasing frequency. In spite of this there have been so far no uniform, objective research methods which could allow their accurate evaluation. This is why the attempt has been made to assess morphological and functional condition of the liver in patients chronically exposed to mercury compounds in the place of settlement. The research group consisted of 62 patients exposed to metallic mercury at a yearly rate exceeding 24 kg for average duration of 16 years. Patients with the liver or biliary tract diseases, symptoms of chronic circulatory insufficiency, Australia (HBs+) antigen carriers and alcoholics were excluded from the research group. The control group consisted of 29 males. AST and ALT activity, prothrombin level, bilirubin and protein concentration in blood serum were measured and scintigraphic and USG examinations of the liver were performed. Mercury concentrations were also established. Scintigraphic examination yielded an abnormal image of the liver in 52% of the exposed patients. The differences in frequency and intensity of scintigraphic changes in comparison with the control group were of statistical significance. No pathological changes were found in USG examination. Significantly higher ALT activity and bilirubin concentration and significantly lower total protein concentration were found in the exposed group. The correlation between the intensity of scintigraphic changes and mercury concentration were noted. Liver scintigraphic examination combined with biochemical analysis allows an assessment of the liver condition in chronic exposure to mercury compounds in the place of settlement.

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.

The drug overdose resulting in acute intoxication diagnosed in the 106 drug abusers in period form June to December 1994. The screening drugs identification was performed using immunoassays Triage and Vitalab Eclair manufactured by MERCK. Benzodiazepines followed by barbiturates and opiods were most often the cause of acute poisonings among the adult Kraków inhabitants. The results presented indicate that only adequate clinical observation, laboratory tests performance and establishing of intoxication state (acute poisoning, chronic intoxication or withdrawal) allows a complete patient evaluation.