[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.

[Endoscopic treatment of chemical burns to the stomach with mucosa ulceration and necrosis].

The prevalence of acute poisoning with caustic substances in Russia is higher than in other countries and is reported by different authors as accounting for 10-32% cases among the patients admitted to acute poisoning treatment centres. Especially unfavorable prognosis is considered for necrotizing burns to the stomach that increase the risk of severe complications leading to disability of patients. The study aimed at improving the treatment of necrotizing chemical burn to the stomach by the infusion of a 5% Mexidole solution into the edges of a burn lesion at different stages of the treatment course. The paper presents the outcomes of patients who sustained chemical burns to the stomach with mucosa ulceration and necrosis, and provides an assessment of early endoscopic treatment effect.

[Antidote therapy for acute carbon monoxide poisoning].

AIM: To evaluate the antidote properties of acizol in acute carbon monoxide poisoning (ACMP). SUBJECTS AND METHODS: The study included 70 patients with ACMP. Of them 35 patients received a package of medical measures, which involved 6% acizol solution injected in a dose of 1 ml on hospital admission and an hour later. The efficacy of acizol was evaluated using clinical and laboratory studies. RESULTS: Just an hour after acizol injection, there was an average 2-fold reduction in the blood concentration of carboxyhemoglobin as compared to the baseline levels. Consciousness recovered 1.5 times more quickly than in the control group. The clinical efficacy of acizol was supported by positive laboratory tests. CONCLUSION: The use of acizol in ACMP assists in increasing the rate of detoxification and positively affects some blood laboratory parameters.

[Morphological aspects of acute intoxication with azaleptin].

Clinico-anatomical analysis, chemico-toxicological and histological examination of material from 54 deceased from intoxication with azaleptin both in urgent toxicology department and pre-admission stage, were performed. Morphology of intoxication with azaleptin was studied, structural base of genopathy at these intoxications was developed.

[Nonspecific resistance in psychotropic agent poisoning complicated with pneumonias].

Nonspecific resistance was studied in patients in acute psychotic poisoning complicated with varying pneumonias. The indices obtained during long (120-min) blood incubation with an object of phagocytosis, namely phagocytic index, phagocytic number, bactericidity index, HCT test, and cytochemical activity index were shown to be of the highest informative value that characterizes the state of nonspecific mechanisms of immune protection. The diminished microphagocytic functional activity along with the severity of pneumonia was ascertained to result in the development of an inflammatory process.

[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.

[The first experience in using the polysegmental bioimpedance analysis to determine the bodily fluid sectors in patients with acute exotoxicoses].

The paper gives the results of studying the body's water sectors by the polysegmental bioimpedance assay in 53 patients with acute poisoning of varying severity by psychotropic agents. It shows it expedient to use this assay to identify early water imbalance and to evaluate the efficiency of therapeutic measures. A primary reaction to acute chemical injury has been ascertained to be characterized by a predominant accumulation of cellular fluid. Progressing extracellular hyperhydration accompanied by increased cellular fluid volumes within the first 3 days after the time of intoxication should be considered to be a poor sign in critically ill patients.

[Geriatric aspects of diagnosis and treatment of psychotropic agent poisonings].

Clinical and laboratory parameters were comparatively assessed in persons from two age groups (15-59 and 60-89 years) on their admission to hospital and in the course of equal treatment. The elderly and senile patients showed a higher incidence of inflammatory complications and death in the toxicogenic and somatogenic phases of acute intoxication with delayed recovery of laboratory parameters.

[Ethyl alcohol-combined and concomitant poisonings by psychotropic agents].

The paper provides the results of examining 474 patients with acute poisonings by psychotropic agents due to their combined use or in combination with ethanol. It shows the frequency of different combinations of psuchotropic drugs and denotes the poorest of them to the outcome of disease. Concomitant poisonings are demonstrated to show a severe course and high death rates whereas poisonings combined with ethanol, if at low blood concentrations, take their better course.

[Effects of chemo-, physiohemotherapy, and medicines on the parameters of oxidative stress in the somatogenic stage of acute poisonings].

To determine the effects of chemo-, physiohemotherapy, and the medicines mexidol and acysole on the blood parameters of oxidative stress, 279 patients were examined in the somatogenic stage of acute poisoning by psychopharmacological agents and cauterants. The time course of changes in individual indices and resultant imbalance was analyzed during various therapeutic options versus traditional treatment. Drug therapy was shown to have a good impact on the parameters of oxidative stress in the somatogenic stage of acute intoxications.

[Efficiency of antioxidative therapy for acute poisoning by cautery substances].

Analysis of the clinical and laboratory parameters in patients with acute poisoning by cauterants has demonstrated that inclusion of the antioxidant mexidole into the package of therapeutic measures is effective in treating the above pathology. This is supported by the reductions in the proportion of fatal outcomes by more than twice and in the incidence of pneumonia complicating the course of the underlying disease, as well as by the increase in the rate of regeneration of ulceronecrotic defects in the gastrointestinal tract and by the decrease in the number of gastric cicatricial deformities when mexidole is locally used.

[Endogenous intoxication parameters in the assessment of a risk for pneumonias in acute azaleptin intoxications].

In cases of acute azaleptin poisoning (AAP), the parameters of endogenous intoxication (EI) were studied in patients both with complicated pneumonias and without them. The integral EI index endogenous intoxication coefficient (Cei) was developed, which simultaneously reflects the coupling capacity of albumin of hydrophilic toxins and lipid peroxidation products: Cei (MMWP x MDA/EAC) x 1000, where MMWP is medium molecular-weight peptides; MDA is malonic dialdehyde; EAC is the effective albumin concentration. The use of Cei significantly enhances the efficiency of diagnosis of early-stage EI and provides a more objective assessment of therapy in AAP patients. EI is more severe when poisoning is concurrent with complicated pneumonias. Cei is of informative value in the assessment of a risk for pneumonias in AAP, which may be used in various emergencies accompanied by EI.

[Esophagogastroimpedancemanometry in diagnosis of gastroesophageal reflux in patients with chemical burns of the stomach].

Esophagogastroimpedancemanometry conducted in 40 patients with chemical bums of the stomach (CBS) in acute and early postburn periods has revealed that CBS affect motor function of the cardia in 95% patients. This motor cardial dysfunction results in erosive and erosive-ulcerous reflux-esophagitis in 22.5% patients. Motor dysfunction of the cardia and esophagitis depends both on CBS severity and time since the trauma. Gastroesophageal reflux in CBS patients is triggered by intragastric hypertension accompanied with lowering of the esophageal-gastric pressure gradient provoking motor dysfunction of the esophagus and reduction of the esophageal clearance.

[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.

[Pathogenetic implication of some laboratory parameters in the development of toxicohypoxic encephalopathy in acute poisoning by psychopharmacological agents].

In 62 patients with acute poisoning, blood gases, immunograms, hemorheology, oxidative stress, and the blood levels of biogenic amines were studied at the toxicogenic and somatogenic stages of poisoning. It was found that the development of toxicohypoxic encephalopathy was affected by the magnitude of changes in laboratory homeostatic parameters among which hemorheological and immunological were prominent.

[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.

[Impaired gastric acid secretion in patients poisoned by cauterizing liquids].

Intragatric pH-metry made in 80 patients with chemical gastric burn (CGB) in the acute and early postburn periods revealed that in 17% of the victims, gastric acid secretion remains normal, 51.2% of cases showed its increase (hyperacidity) whose maximum rates (100%) are detected in patients with extensive CGB of the third degree and whose minimum rates (20%) were found in those with fourth-grade CGB. Hypoacidicity was diagnosed in 31.2% of the patients. A significant (1.7-6-fold) enhancement of acid secretion was observed during stimulation, which suggests the compensated hyperfunction of intact gastric mucosal portions and supports the fact that the values of basal acidicity are leveled by bile reflux duodenogastritis. The latter was diagnosed by pH-metry data in 63.8% and by esophagogastroduodenoscopy (EGDS) in 87.5% of cases. The detection rate of reflux gastroesophagitis (RGE) was also higher by EGDS than that by pH-metry: 42.5 and 26.3% of cases, respectively. The lowest detection rate of RGE was noted in patients with fourth-degree CGB whereas the endoscopic signs of reflex esophagitis (RE) were most pronounced: erosive and ulcerative RE was diagnosed in 28% of cases.

[The prognostic value of albumin fluorescence test in the evaluation of outcome of acute intoxication with psychotropics]. / Prognosticheskaia tsennost' al'buminovogo fliuorestsentnogo testa v otsenke iskhoda ostrykh otravlenii psikhotropnymi sredstvami.

Two hundred and five patients with toxicogenic and somatogenic intoxication with psychotropics (PT) were examined for the purpose of evaluating the prognostic value of the albumin fluorescence test. An analysis of distributions of laboratory indices in the groups of survived (n = 176) and diseased (n = 29) patients demonstrated the following: the parameter "efficient albumin concentration" (EAC) measured by fluorescence is informative in respect to prognosticating an outcome of PT intoxication of both toxicogenic and somatogenic forms. EAC provides for isolating a subgroup of patients with the risk of unfavorable outcome that is 3-4-fold higher versus the mean value. The routine laboratory parameters, e.g. level of creatinine, serum urea, are rather of a less prognostic significance versus the EAC fluorescence parameter.

[Influence of gastroesophageal reflux on the reparative process in burn of the esophagus]. / Vliianie zheludochno-pishchevodnogo refliuksa na techenie reparativnykh protsessov pri ozhoge pishchevoda.

Experience in endoscopic examination and treatment of 282 patients with isolated and combined chemical burn of the esophagus (CBE) of different severity is presented. Endoscopic treatment, performed in combination with chemotherapy, consisted in irradiation of burn surface with low-energy laser 'Mustang' through the canal of the endoscope. The procedure was performed 3 times a week up to complete epithelization of burn ulcers. Both in primary esophagogastroduodenoscopy and in repeated examinations sphincter function of the cardia, presence and sizes of axial hiatal hernia, changes of esophageal mucosa and presence of gastroesophageal reflux were analyzed. It is demonstrated that CBE was associated with dysfunction of the cardia in more than 90% cases. Rate of erosive and ulcerous reflux-esophagitis was 24.6-34%; cicatrix stricture of the esophagus - 6.3-12.2% in isolated and combined CBE, respectively. Severity of reflux-esophagitis and its complications was determined by severity of chemical burn.