[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%.

[Oxidative activity of electrochemically synthesized sodium persulfate solutions against some psychotropic agents].

By using some psychotropic agents as an example, investigations of the oxidative activity of electrochemically synthesized sodium persulfate solutions were continued. The derivatives of phenothiazines, xanthene, and dibenzazepines were shown to be oxidized by synthesized sodium persulfate solution to low-toxic products. Oxidation products were ascertained to coincide with the known products of their biotransformation in the body.

[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.

[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.

[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.

[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.

[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.

[Disorders of lipid peroxidation processes and blood antioxidant system in acute poisoning with psychotropic drugs]. / Narusheniia protsessov perekisnogo okisleniia lipidov i antioksidantnoi sistemy krovi pri ostrykh otravleniiakh psikhotropnymi preparatami.

Study of lipid peroxidation (LPO) processes and antioxidant defense (AOD) system of the blood in 96 patients with psychotropic drug poisoning of different severity showed disorders in the LPO/AOD system irrespective of the initial level of chemical injury. These disorders are characterized by imbalance in the ratio of LPO and AOD components. The severity and direction of these disorders depend on the severity of intoxication and poison exposure in the body before treatment measures, which dictates correction of these disorders with consideration for individual LPO and AOD parameters.

[Time course of toxic hypoxic encephalopathy during combined therapy including hyperbaric oxygenation]. / Dinamika toksikogipoksicheskoi éntsefalopatii pod vozdeistviem kompleksnogo lecheniia s primeneniem giperbaricheskoi oksigenatsii.

The mechanisms of action of hyperbaric oxygenation (HBO) in toxic hypoxic encephalopathy (THE) were studied using clinical psychopathological examinations, functional and laboratory tests in 268 patients with THE treated by a therapeutic complex including HBO and 75 patients with THE treated routinely (controls). The earliest possible addition of HBO to a complex of treatment of THE patients led to involution of signs of brain edema shown by computer tomography (CT) and improvement of its functional activity, while in patients exposed to HBO later the psychoorganic symptoms and CT signs of cerebral ischemia did not disappear. Detoxifying, neuroimmunomodulating, and neuroimmunostimulating effects of HBO in THE were demonstrated. Early HBO treatment decreased the dysfunction of various compartments of the brain characteristic of THE. The technology of HBO developed by the authors prevented the development of socially dysadapting psychoneurological disorders and reduced the mortality of THE patients.

[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).

[Use of SGOL-1-40 milk whey in the complex therapy of patients with acute chemical poisoning and burns of the gastrointestinal tract]. / Ispol'zovanie molochnoi fermentirovannoi syvorotki SGOL-1-40 v kompleksnom lechenii ostrykh khimicheskikh boleznei i ozhogov zheludochno-kishechnogo trakta.

The use of "SGOL-1-40" milk whey in complex therapy of patients with acute chemical poisonings and their complications has been investigated. "SGOL-1-40" was prescribed twice per day with the dose of 1.5 g/kg of patient weight. On the 5th-6th day after therapy start the general state of patients improved; in the control group it happened on the 10th-12th day. It is ascertained that the ceasing of pneumonia takes place average 3 days earlier than usual. The lessening of endotoxicosis symptoms and the improvement of the patients state with chemical burns of gastrointestinal system went on more quickly.

Clinical and institutional aspects of antidote therapy in Russia.

The problem of antidote application for treatment of acute poisoning is related to epidemiology and characterization of poisoning cases, and possibilities for supplying antidotes to health care institutions. To investigate the situation in Russia we have analyzed reports by poisoning treatment centers for 1997-1999, comparison of medical aid standards for poisoning treatment in Russia with WHO recommendations. Acute poisoning pattern varies in different regions. Particularly, poisoning pattern in large cities in European Russia and the Urals is dominated by pharmaceuticals (up to 63.1%). Pesticide and insecticide poisoning cases do not exceed 1 to 2%, metal compounds and methemoglobin forming poisons (below 1% in each group). Antidotes are used in Russia in line with the recommendations adopted in international toxicological practice. The most actual are antagonists of opiates and benzodiazepines, physostigmine, atropine, pyridoxine, antagonists of beta-adrenergic blockers, activated charcoal. Such antidotes as DMPS (Unithiol), N-acetylcysteine, methylene blue, amyl nitrite (or sodium nitrite), complex formers of EDTA group are also included in the list of specific agents. The main problem is that some important antidotes are currently not produced in Russia. The Ministry of Health of the Russian Federation is taking efforts to launch production of some previously known and also newly developed important antidotes.

[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.