Repeated self-mutilation of testicles in the context of methamphetamine use - A case report and brief review of literature.

We report a case of recurrent genital self-mutilation (GSM) after use of methamphetamine. A 29-year-old male with borderline personality and polydrug misuse attempted the GSM twice. Firstly, he self-amputated his left testicle, and one year later he injected printer ink in his right testicle. An open revision of the injured area revealed a puncture wound in the right testicle, with a palpable accumulation of fluid. No ink was found inside the scrotal sac suggesting that the substance was injected directly to the testis. Due to the absence of left testicle, the urologist decided against orchiectomy. Blue colour of serum, urine and sperm was observed for nine days, and then spontaneously disappeared. An ultrasound imaging showed enlargement of the right testis with hypoechogenic fluid/ink collection. Pathomorphological examination of the testicular tissue revealed focal necrosis and diffuse suppurative inflammation of the testicular tunic. Examination of the sperm showed significantly reduced amount of sperm, with majority of dead spermatocytes. Follow-up examination at six months and two years showed absence of spermatocytes. Some attempts of GSM can be repeated. Therefore, specific preventive measures should be undertaken whenever a standard advice and motivational interviewing proved ineffective. Depending on local and general toxicity of an injected xenobiotic, orchiectomy should be considered as a treatment option of GSM. Injection of potentially low toxic ink into the testicle can lead to its permanent damage and infertility.

[Accidental poisoning with peach seeds used as anticancer therapy--report of two cases]. / Przypadkowe zatrucie pestkami brzoskwini stosowanymi w celach przeciwnowotworowych--opis dwóch przypadków.

UNLABELLED: We described two cases of poisoning with amygdalin. Clinical signs presented by two females were mild and lasted up to 5 hours. CONCLUSIONS: The usage of amygdalin may be connected with serious side effects. The cyanide and prussic acid which are deliberated in digestive system are responsible for toxicity in such cases. The rarity of poisoning with amygdalin as well as high cost of analysis are responsible for the reason that most labs are not prepare for such procedure.

[Acute intoxication with nutmeg used as a recreational purpose--a case report]. / Ostre zatrucie galka muszkatolowa stosowana w celach rekreacyjnych--opis przypadku.

We present a case of acute nutmeg poisoning used for recreational purposes. Poisoning had a stormy clinical course with symptoms of gastrointestinal, cardiovascular and nervous system. The widespread availability of nutmeg suggests that real number of these poisonings may be underestimated in our country.

[Nicotine experiences among students of the Medical University of Gdansk]. / Doswiadczenia nikotynowe studentów Gdanskiego Uniwersytetu Medycznego.

In the years 2009 and 2010, a study of the assessment of nicotine experience and exposure to cigarette smoking among the students of Medical University of Gdansk were done. 410 students were included to the study. The authors used anonymous on-line survey. Relatively low percentage of smokers was found in the population of students of Medical University of Gdansk. Smoking persons usually smoke few cigarettes per week. Only 33% of students want to give up smoking.

Suicidal intoxication with potassium chlorate successfully treated with renal replacement therapy and extracorporeal liver support.

We present a case of a 22-year-old male who, in a suicide attempt, ingested approximately 200 g of potassium chlorate. Upon admission to the hospital, he presented in full respiratory failure with cyanosis. Methylene blue antidote was given but found to be ineffective. The patient was intubated and mechanical ventilation was initiated. Because of renal failure with anuria, intermittent haemodialysis (iHD) followed by continuous venovenous hemodiafiltration (CVVHDF) was performed. His hospital stay was also complicated by hemolysis, disseminated intravascular coagulation, and atrial fibrillation. Transfusions of packed red blood cells, platelets, and fresh frozen plasma were necessary to correct the deficits. He also developed liver failure and required two sessions of molecular adsorbent recirculating system (MARS) therapy. On day 14 of his hospitalization, he regained consciousness, as well as full respiratory and circulatory function. There are no controlled studies addressing management of potassium chlorate poisoning. We suggest that early renal replacement therapy should be strongly considered.

[Atypical poisoning with mixture of toxic alcohols--a case report]. / Nietypowe zatrucie mieszanina alkoholi niespozywczych--opis przypadku.

UNLABELLED: We presented the male who was addicted to ethanol, and who drank the mixture of different toxic alcohols. Toxicological screening of ingested fluid found 42% vol propan-1-OL, and 17% vol propan-2-OL (isopropanol). After regaining consciousness, the patient stated that substance is becoming more and more popular as a new type of cheap alcohol, and because of its "low price and high power". CONCLUSIONS: 1. It is advisable to consult all cases of poisoning with inedible alcohols with Regional Centers of Toxicology. 2. There is an urgent need to create a reference toxicological laboratories, which would have the ability to diagnose poisoning with different xenobiotics. 3. Further training for students and doctors, about diagnosis and therapy of acute poisonings, should be done. 4. The endemic foci of intoxication with inedible alcohols should be checked and discovered.

Accidental intoxication with high dose of methoxetamine (MXE)--a case report.

UNLABELLED: Methoxetamine (MXE) is an analogue of ketamine. CASE REPORT: We present a 25-year-old male who, after getting an information from the Internet, started to use MXE to avoid the excitement connected with recreational codeine abuse. For about 8 - 10 months he injected about 100 mg of MXE intramuscularly. On the day of admission the patient decided to take much higher dose of 750 mg of MXE. For the first 3-4 hours of hospitalization the profound agitation, which demanded the usage of high doses of benzodiazepines, was observed every several minutes. After 6-7 hours of supportive treatment the patient returned to his baseline mental status. CONCLUSION: MXE presents the new healthcare threat because of easy accessibility via Internet, and lack of legal restrictions in many countries. The low dose of MXE can cause "peace and serenity", however, higher dose may act opposite.

[Analysis of exposure to pepper spray as a part of preparing hospital to help victims of mass chemical incidents]. / Analiza narazenia na gaz pieprzowy jako element przygotowania szpitala do pomocy ofiarom masowych skazen chemicznych.

We analyzed an incident of exposure to pepper spray 35 persons, including 29 children. Medical procedures were difficult because of the lack of reliable information about the nature of exposure, lack of hospital action plan for chemical accidents and established principles of cooperation with poison control center, as well as the need of extensive medical documentation for each patient.

[SPAD--new possibilities?]. / SPAD--nowe mozliwosci?

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.

[Reactive oxygen species and 3,4-dihydroxyphenylacetaldehyde in pathogenesis of Parkinson disease]. / Reaktywne formy tlenu i aldehyd 3,4-dihydroksyfenylooctowy w patogenezie choroby Parkinsona.

Reactive oxygen species, which plays a role in pathogenesis of many neurodegenerative diseases, seems to be important also in pathogenesis of the Parkinson's disease. Experiments performed recently, revealed in the cerebrum of patients suffering from this disease (induced by the oxidative stress) elevated levels of 3,4-dihydroxyphenylacetaldehyde (DOPAL)--a strong endogenous neurotoxin to dopamine neurons.

Acute dermal and inhalation exposure to 4-vinylpyridine--a case report.

INTRODUCTION: To the best of our knowledge there are only few reports in medical literature concerning the acute dermal exposure to 4-Vinylpyridine (4-VP). We describe a dermal and inhalation exposure to 4-VP followed by systemic symptoms and local injury. CASE REPORT: A 58-year old female, with non significant previous medical history, was admitted to the ward with the signs of vertigo, weakness and local pain in the foot dorsal region after exposition to few drops of 4-VP. After 7 days of the treatment all symptoms resolved. CONCLUSION: Vinylpyridines are irritant and corrosive substances which can lead to skin damage. In case of inhalation exposure the late onset of systemic symptoms should be taken into account.

[Resurgence in paramethoxamphetamine use. Review of poisonings and two recent cases study]. / Powrót do uzywania parametoksyamfetaminy. Przeglad zatruc i studium dwóch nowych przypadków.

Two recent cases of death due to p-methoxyamphetamine (PAM) intake, a methoxylated phenethylamine derivative, were described and compared with previous PMA related deaths that occurred in many countries. Following a review of the available literature from 1974 to 2011 three periods of resurgence of an unsuspected increase of lethal PMA causation were considered. Signs of intoxications, concentrations of PMA found in biological materials were discussed. Based on the case reports can be concluded the great number of victims were unconscious of taking PMA as substitute of MDMA. Two new methods for screening, identification and quantification of amphetamine derivatives in biosamples (blood and urine) using LC-MS/MS techniques were developed. The methods have proven to be appropriate for clinical and forensic toxicology purposes.

[Unusual cases of anisocoria--report of two cases]. / Nietypowe przypadki anizokorii--opis dwóch przypadków.

We presented two cases of anisocoria involved with accidental intoxication of mydiatrics. Both patient were in good health condition and did not have any anomalies in ophtalmological and neurological examinations. An asymmetry of papilla receded spontaneously. Anisocoria was not the symptom of any systemic illness.

[Accidental intoxication with eucalyptus oil--a case report]. / Przypadkowe zatrucie olejem eukaliptusowym--opis przypadku.

Eucalyptus oil (EO) intoxications are rare. We present a case of 58 yrs old chemist, who due to intense delusions consumed 4-5 drops of concentrated EO in order to self-medication of ascariasis. Despite the low dose of ingested xenobiotic the course of poisoning was severe. The intoxication was complicated with acute lung and heart injury, tachycardia and hypertension. Most of the clinical symptoms and biochemical abnormalities disappeared after the treatment.

[Psychosis caused by the treatment with clarithromycin--a case report]. / Psychoza spowodowana terapia klarytromycyna--opis przypadku.

We present a case of psychosis caused by intake of clarithromycin in a young, healthy patient. Disturbance of consciousness occurred a few hours after the intake of the first dose and persisted for four days after drug discontinuation. Conducted numerous medical tests excluded other possible causes of psychotic disorders. The patient was observed in hospital, without using antipsychotic preparations up to the spontaneous resolution of the aforementioned disorders.

[The lower legs amputation--rare side effects of acute poisoning]. / Amputacja konczyn dolnych--rzadkie powiklanie ostrego zatrucia lekami.

UNLABELLED: The paper describes a case of suicidal poisoning with a combined hypotensive drug. CASE REPORT: A 46-year old man ingested, with a suicidal intent, a 0.5 l of vodka and around 20 tabl. of Tarka contains 180 mg of verapamil and 2 mg of trandolapril in 1 tablet. Despite intensive supportive treatment no reperfusion was achieved, and it was necessary to amputate both legs below knees. CONCLUSIONS: Acute overdoses of Tarka may be severe in spite of relatively small amounts of drug ingested by patients (from 5 to 20 tablets). In light of reports of severe ischemic complications, which seem to have thrombotic etiology, it seems advisable to employ prophylaxis with anticoagulants, especially in patients with resistant hypotension. Ischemic complications, which may result in amputation, may present long time after hemodynamic stabilization is achieved.

[Visual impairment caused by recreational usage of cocaine--a case report]. / Niedowidzenie spowodowane rekreacyjnym stosowaniem kokainy--opis przypadku.

We presented a case of sudden and painless vision impairment connected with the recreational usage of cocaine. According to many authors illicit use of cocaine has been associated with the most common adverse effect among all psychoactive drugs. In the last years there were a few articles about vision problems after the usage of cocaine. In most cases the main mechanism was central retinal artery occlusion (CRAO). The vision impairment developed from 3 to 10 hrs after the cocaine use and the outcome, despite the intensive treatment, was usually poor. All doctors should keep in mind the possibility of cocaine usage, in young and healthy people, who developed a sudden and painless vision loss.

[Selected cases of acute intoxication with metallic mercury]. / Wybrane przypadki zatruc rtecia metaliczna.

We presented six different cases of poisoning with metallic mercury, which were hospitalized between the year 1999 and 2010 in toxicological center in Gdansk. We discussed also the mechanism, method of diagnosis and therapy of this type of intoxication.

The social support to patients after suicidal attempts provided by the nurses in Clinic of Acute Poisonings Medical University of Gdansk.

Nurses and other medical workers have wide ability to provide positive support to patients with low self-esteem. Need of this support is even more important because patients who have tried to attempt suicide are surprisingly less likely to express their needs than other patients. The aim of study was the evaluation of social support provided by nurses working in the Clinic of Acute Poisonings Medical University of Gdansk to the patients after suicidal attempts. Questionnaire investigation was performed on 40 patients including 32 women and 8 men aged from 14 to 53 (mean 31.4 +/- 13.5) years. Needs and requests of patients after suicidal attempts were mainly limited to getting a proper medical consultation and adequate information. Social support (emotional, valuational, instrumental, informational) provided by nurses proved to be a very important factor in treating patients after suicidal attempts.