[Homeostasis changes during rehabilitation period after acute chemical poisoning].

The article deals with review of 78 patients of rehabilitation toxicological unit. The patients received resuscitation and detoxification. All patients were divided into three groups; 1st group--patients after poisoning with psychopharmaceuticals, 2nd group--patients after poisoning with cauterizing liquids and 3rd group--patients with encephalopathy after poisoning with neurotoxin (psychopharmaceuticals, narcotics and ethanol). Disorders of rheology, haemostasis and endotoxicosis accrued in all groups. These disorders were a signs of the erythrocytes and platelets aggregation developing and viscoelasticity disorder. Homeostasis changes during rehabilitation period need an accurate diagnostics for purposeful treatment of the defined disorders.

[Laws and regulations affecting the development of national service of clinical toxicology].

In the formation and development of the national specialized toxicological service the important role was played by legislative initiatives, distinguished with continuity and improvement of the quality of care in acute poisoning, principles of interaction of units of service. Since the beginning of the organization of specialized toxicological service in the country, without taking into account the regional regulations, there were published over thirty ones, impact and significance of which can be very positively evaluated by formed a unique and authoritative national school of clinical toxicology, with its wealth of organizational, methodological and diagnostic and treatment practices, valuable scientific and human resources.

[Retrospective view of the use of detoxifying hemosorption for the treatment of acute exogenous poisoning].

Results of the treatment of almost 5000 patients with severe forms of acute poisoning by hemosorption (HS) using non-selective hemosorbents is a basic method comprising specific and non-specific therapeutic modalities that facilitate removal of toxicants of different nature from the human body. It is shown that natural biotransformation of toxicants and correction of disturbed hemostasis can be accelerated by a combination of HS and physico-chemical hemotherapy (magnetic, UV, and laser therapy, indirect electrochemical blood oxidation by sodium hypochlorite) that promotes further significant increase in the toxicant removal rate. Improvement of detoxification therapy by combining HS with other afferent methods for detoxification and physico-chemical hemotherapy allowed the mortality rate in the department of emergency antitoxic therapy to be reduced by a factor of 3, from 14.5 to 5.8%.

[Problems in the standardization of inpatient health care in clinical toxicology].

Standardization of inpatient toxicological care is an urgent task to reduce mortality from acute chemical poisonings. Since 2005, health care standards and patient management protocols in poisonings with psychotropic and hypnotic agents, ethanol and other alcohols, and ethylene glycol have been developed and work is in progress on standards for intoxication with corrosive substances, soaps, detergents, carbon dioxide, other gases, smokes, and vapors. Major difficulties have been revealed. These are the lack of coincidence of the "Nomenclature of work and services in public health service" at the federal level with the similar regional documents; improper presentation of toxicological diagnostic and medical technologies; orientation of the Ministry of Health and Social Development of Russia towards only simple services; the "List of Essential and Most Important Drugs" that does not contain the heading "antidote agents" at all is to be completed.

[Problem in the rehabilitation of patients with acute chemical poisonings in the toxicological hospital].

Follow-ups of 693 patients treated at the rehabilitation toxicological department for poisonings with psychopharmacological agents (n=549), cauterants (n=72), and opium narcotics (n=72) were summarized. Moreover, factors, such as the development of complications and the prehospitalization psychosomatic status of patients, influenced the length stay in a unit. Treatment of such patients should be aimed at eliminating at once a few causes that negatively affect the course of recovery for which it is expedient to use the methods of physicochemical hemotherapy, mesodiencephalic modulation, intestinal lavage, and hyperbaric oxygenation.

[Use of sodium hypochlorite in therapy for acute intoxications with methemoglobin formers].

The study of these intoxications has demonstrated that the blood level of methemoglobin (MH) is in conformity with the severity of intoxication. The pathospecific therapeutic effect of sodium hypochlorite (SHC) in acute intoxications of varying severity has been found to appear as a significant intensification of demethemoglobinization and as a three-fold reduction in the half-life of MH. The nonspecific effect of SHC manifests itself in correcting metabolic acidosis and in improving blood oxygenation. The use of SHC accelerates the regression of clinical manifestations of disease and reduces the length of inpatient treatment.

[Interrelationship between platelet nitric oxide production and plasma fibrinogen level in emergencies].

Platelet nitric oxide production has been investigated in patients with thoracic and abdominal wounds, thermal trauma, varicose disease, methanol and leponex poisoning. There is correlation between absolute platelets nitric oxide production and fibrinogen plasma level in these patients. The maximal absolute platelets nitric oxide production has been revealed at surgical diseases, and minimal has been observed at methanol poisoning. Irrespectively to etiology and danger of disease, reliable correlation between absolute platelets nitric oxide production and fibrinogen plasma level of these patients is established. Consequently platelets nitric oxide production may be important for haemostatic processes.

[The specific features of the development and course of toxicohypoxic encephalopathy in acute poisoning by neurotoxic agents].

The time course of changes in the development of toxicohypoxic encephalopathy in acute poisoning by neurotoxic agents was studied. Programmed treatment using efferent detoxifying, physio- and chemohemotherapy, and hyperbaric oxygenation and cytoflavin was proposed.

[Transcranial electrical stimulation in the treatment of toxicohypoxic encephalopathy at the early stage of inpatient rehabilitation].

The authors studied the time course of clinical and neuropsychological changes in the use of transcranial mesodiencephalic modulation in the complex treatment of patients with acute poisoning by neurotropic toxicants, which were complicated by toxicohypoxic encephalopathy. The findings suggest the beneficial impact of this technique on the autonomic functions of the brain stem, on the body's adaptive capacities and the psychoemotional sphere, which makes it possible to recommend the programmed use of this method in such patients.

[Laboratory changes in exo- and endotoxemia in toxicohypoxic encephalopathy occurring with acute poisoning by psychopharmacological agents].

Examinations of patients with acute oral poisoning by psychotropic agents have indicated that toxicohypoxic encephalopathy develops, when the high concentrations of toxicants and their active metabolites specifically affect brain structures, resulting in oxidative stress and impaired natural detoxification mechanisms.

[Effect of sodium hypochlorite on the biotransformation of toxicants in acute poisoning by psychotropic agents].

In acute poisoning by amitriptyline, carbazepine, barbiturates, and ethanol, the effect of sodium hypochlorite on the metabolism of toxicants is manifested as a considerable reduction in their high blood concentrations through oxidative transformation to inactive water-soluble derivatives and as the enhanced urinary elimination of the latter. The rate of the above process depends on the used dose of sodium hypochlorite.

[Features of diagnosis and treatment of endotoxicosis syndrome in acute chemical poisoning]. / Osobennosti diagnostiki i lecheniia sindroma éndotoksikoza pri ostrykh otravleniiakh khimicheskoi étiologii.

Experience gained in the treatment of more than 750 patients with acute poisoning complicated by endotoxicosis showed that the entire complex of typical changes in endotoxicosis markers and homeostasis parameters (hematological, immunological, hemorheological, LPO/AOD) should be taken into consideration during the diagnostic studies. These shifts should be timely corrected by the basic efferent methods of artificial detoxication (hemosorption, hemodiafiltration, hemofiltration) with obligatory physio- and chemohemotherapy (laser-UV hemotherapy, infusion of sodium hypochlorite).

[Clinical toxicology on the threshold of the 21st century]. / Klinicheskaia toksikologiia na rubezhe XXI veka.

Progress in clinical toxicology implies search for new approaches to improving the intensity of urgent detoxication in patients with acute poisoning by stimulating the natural cleansing of the organism, improving complex detoxication as part of adsorption, dialysis filtration, apheretic, and physiohemotherapeutic procedures, and creation of new specific (antidote) drugs). Progress in clinical diagnosis requires further research of new types of acute poisoning and the endotoxicosis syndrome and development of information and consultation service for such cases.

[Electrochemically regulated hemosorption detoxification]. / Elektrokhimicheski upravliaemaia gemosorbtsionnaia detoksikatsiia.

Study of the relationship between activated charcoal potential and its effects and the biological media and organic toxic agents is in progress. Using the electrochemical model of hemoperfusion proposed previously, the authors defined the optimal conditions for modifying the hemoadsorbents from activated charcoal, carried out monitored hemoperfusion detoxication in patients, and improved the results of treatment in patients with acute poisonings with organophosphorus compounds, psychotropic and soporific agents, and with 1,2-dichloroethane.

[Detoxicating effects of physico-chemical hemotherapy in acute exogenous poisoning]. / Detoksikatsionnye éfffekty fiziko-khimicheskoi gemoterapii pri ostrykh ékzogennykh otravleniiakh.

Physical factors (magnetic fields and UV and laser exposure) improve the blood status and sodium hypochlorite therapy accelerates removal of exo- and endogenic toxic substances from the organism, as was demonstrated in more than 1200 patients with various intoxications. These effects are due to activation of the detoxication systems of the organism and more rapid removal of some toxic agents from the blood during hemoperfusion. Adequate dosing of these exposures by means of clinical dosimetry will improve the efficacy and safety of detoxication.

[Use of serotonin adipinate in combined therapy of hemodynamic disorders in acute poisoning by psychopharmacological preparations]. / Primenenie serotonina adipinata v kompleksnoi terapii narushenii gemodinamiki pri ostrykh otravleniiakh psikhofarmakologicheskimi preparatami.

Serotonin adipinate in a dose of 40-60 mg was injected by drip infusion to 30 patients with acute poisoning by psychotropic drugs for correcting circulatory disorders. The drug corrected hemodynamic disorders in the lesser and greater circulation by increasing the stroke volume and normalizing total peripheral vascular resistance and central blood volume.

[The mechanisms of action of extracorporeal helium-neon laser irradiation in acute exogenous poisonings]. / Nekotorye mekhanizmy deistviia ékstrakorporal'nogo gelii-neonovogo lazernogo oblucheniia pri ostrykh ékzogennykh otravleniiakh.

Extracorporeal exposure to LG-79 He-Ne laser of 12 mWt power was used in 57 patients hospitalized at the intoxication reanimation department with acute poisonings with psychotropic drugs. The clinical result was a decrease of the incidence of pneumonia in the patients with x-ray signs of venous congestion from 52% among those administered to physiochemotherapy to 24% after this treatment modality. Laser hemotherapy brought about a temporary normalization of the erythrocyte membrane permeability, which was changed biophysically by means of a diffractometer. Red cell aggregation was approximating the norm, decreasing by 20%, and platelet aggregation decreased by 17%. Analysis of the results brought as to a conclusion that He-Ne laser exposure is an effective source of singlet stimulation of molecular O2 evenly dissolved in the blood, which causes resonance oscillations of water difields. This leads to membrane depolarization, which is probably responsible for purification of polarized membranes from toxic agents fixed by them.

[Current problems in the diagnosis and treatment of acute exogenous poisonings]. / Aktual'nye problemy diagnostiki i lechenniia ostrykh ékzogennykh otravlenii.

Information, toxicometry and detoxication are most important problems of clinical toxicology today because exchange of information perfect the skill of toxicologist in diagnosis and choice of treatment, whereas measurement of the toxic factor, blood poison concentrations enables systemic computer analysis of critical conditions caused by poisonings. Treatment of acute poisoning produces the highest effect if detoxication method is used including blood detoxication by sorption-dialysis methods and intestinal lavage in combination with physiohemotherapy. This approach provides a rapid elimination of poison from the body and effective correction of homeostasis.