Parenteral support and micronutrient deficiencies in children with short bowel syndrome: A comprehensive retrospective study.

BACKGROUND & AIMS: Short bowel syndrome (SBS) is the leading cause of chronic intestinal failure. The duration of parenteral support (PS) and the long-term micronutrient needs in children with SBS vary, based on their clinical and anatomical characteristics. Our study aimed to review the clinical course and identify high risk patient groups for prolonged PS and long-term micronutrient supplementation. METHODS: A retrospective review was conducted on electronic medical records of children with SBS and chronic intestinal failure who were enrolled in the multidisciplinary intestinal rehabilitation program at Manchester Children's Hospital, UK. Children were included in the review if they required PN for more than 60 days out of 74 consecutive days and had at least 3 years of follow-up. Statistical analysis was performed using IBM SPSS Statistics 24.0. RESULTS: 40 children with SBS achieved enteral autonomy (EA) and 14 remained dependent on PS after 36 months of follow up. Necrotizing enterocolitis was the most common cause for intestinal resection (38.9%) followed by gastroschisis (22.2%), malrotation with volvulus (20.4%), segmental volvulus (9.3%) and long segment Hirschsprung disease (1.9%). Those who achieved EA had significantly longer intestinal length 27.5% (15.0-39.3) than those who remained on PS 6.0% (1.5-12.5) (p < 0.001). Type I SBS was only found in the PS cohort. Median PN dependence was 10.82 months [IQR 5.73-20.78]. Congenital diagnosis was associated with longer PN dependence (21.0 ± 20.0) than acquired (8.7 ± 7.8 months), (p = 0.02). The need for micronutrient supplementation was assessed after the transition to EA; 87.5% children had at least one micronutrient depletion, most commonly Vitamin D (64.1%), followed by iron (48.7%), Vitamin B12 (34.2%), and vitamin E (28.6%). Iron deficiency and vitamin A depletion were correlated with longer PS after multivariate analysis (OR: 1.103, 1.006-1.210, p = 0.037 and OR: 1.048, 0.998-1.102, p = 0.062 respectively). CONCLUSION: In our cohort, small bowel length was the main predictor for EA. Children on longer PS, had more often a congenital cause of resection and were at risk for micronutrient deficiencies in EA.

Dialkyl phosphates in amniotic fluid as a biomarker of fetal exposure to organophosphates in Crete, Greece; association with fetal growth.

The aim of this study was to evaluate fetal exposure to organophosphate pesticides (OPs) by measuring their non-specific dialkyl-phosphate metabolites (DAPs) in amniotic fluid (AF), and to examine the potential association between prenatal exposure and fetal growth. AF samples were collected from 415 women during the second gestational trimester. The determined OPs metabolites were DMP, DMTP, DEP, DETP, and DEDTP. DAPs were extracted by liquid-solid extraction, derivatized and analyzed by gas chromatography-mass spectrometry. 97.8% of AF samples were positive for at least one DAP. DAPs levels did not differ between urban and rural areas. Macrosomic neonates have significantly higher sum levels of DMPs (p=0.043), which exerted a linear positive association with birth-weight centile (b=4.43, p=0.016). Conclusively, as DAPs are detectable in AF they may be used as a potential biomarker of fetal exposure to OPs. Sum levels of DMPs appear to be associated with birth weight independently of other covariates.

Clinical significance of sCD105 in angiogenesis and disease activity in multiple myeloma.

BACKGROUND: Τhe importance of angiogenesis in malignancies' growth is well recognized. CD105 (Endoglin), a proliferation-associated glycoprotein, is a powerful marker of neovascularization. Elevated amounts of soluble CD105 (sCD105) have been identified in selected solid tumors. The aim of the study was to estimate circulating levels of sCD105 and soluble transforming growth factor-ß(1) (sTGF-ß(1)), in multiple myeloma (MM) patients, to determine their significance in tumor progression and to investigate the correlation between sCD105 and markers of disease activity. METHODS: We studied 50 newly diagnosed MM patients. Twenty-five of them were also investigated in plateauphase. Twenty patients with monoclonal gammopathy of undetermined significance (MGUS) were enrolled in this study. As control group 28 healthy persons were studied. We determined sCD105, sTGF-ß(1) and interleukin-6 (IL-6) in the serum, Ki-67 proliferation index (Ki-67 PI) expression and microvascular density(MVD) in bone marrow with immunohistochemistry. RESULTS: The mean concentrations of sCD105 and IL-6 were higher in MM and MGUS patients compared to controls, whereas serum levels of sTGF-ß(1) were lower in MM patients compared to MGUS patients and controls. sCD105 levels, were significantly different among disease stages, with higher values in advanced stages. It was found that sCD105 correlated with Ki-67 PI, MVD and IL-6. CONCLUSIONS: CD105 seems to play an important role in angiogenesis and tumor progression. Circulating levels of sCD105 could detect patients with more advanced disease and might help in evaluating the response to treatment.

Serum BAFF levels are related to angiogenesis and prognosis in patients with multiple myeloma.

B-cell activating factor (BAFF) is a B-cell growth factor. We measured its serum levels and correlated them with parameters of disease activity, as serum levels of tumor necrosis factor-α and lactate dehydrogenase, bone marrow microvascular density and proliferating cell nuclear antigen expression, in 50 myeloma patients, in 22 of them in plateau phase and in 20 controls. All of them were higher in patients and in advanced disease while reduced in plateau phase. BAFF correlated with all the above markers. Higher BAFF levels predicted a shorter survival, suggesting an important prognostic marker and a possible therapeutic target in myeloma.

Is hair analysis for dialkyl phosphate metabolites a suitable biomarker for assessing past acute exposure to organophosphate pesticides?

In the present paper, the possibility to use dialkyl phosphate metabolites (DAPs) hair segmental analysis as a biomarker of past acute exposure to organophosphates is examined. Hair samples of four acute poisoning survivors were collected and segmental hair analysis was performed. The total hair samples were divided to 1 cm segments and analysed by gas chromatography-mass spectrometry (GC-MS) for the presence of four DAP metabolites, dimethyl phosphate (DMP), diethyl phosphate (DEP), diethyl thiophosphate (DETP) and diethyl dithiophosphate (DEDTP). Results were examined under the light of pesticide type and time of hair sample collection. Although DAPs were detected all along the hair shaft, higher concentrations (peaks) were detected in the segments proximate to the suicide period. It was also observed that the elevated concentrations of the present metabolites corresponded to the ones produced by the ingested parent compound. Conclusively, measurements of DAPs in the appropriate hair segments of OP-poisoned patients can be used for assessing past acute exposure to organophosphates in certain cases.

Monitoring serum levels ELR+ CXC chemokines and the relationship between microvessel density and angiogenic growth factors in multiple myeloma.

BACKGROUND: The ELR+ CXC chemokines are important mediators of tumorigenesis, related to their angiogenic properties. Angiogenesis appears to be a prominent feature in the progression of multiple myeloma (MM). CXC chemokines have four highly conserved cysteine amino acid residues, with the first two cysteine molecules separated by a single amino acid. The angiogenic potential of this group is determined by the presence of three amino acid residues (Glu-Leu-Arg: the ELR motif) preceding the first cysteine amino acid, in the NH2 terminus. AIMS: The purpose of this study was to determine serum concentrations of angiogenesis-related chemokines ELR+ motif, such as interleukin-8 (IL-8), epithelial neutrophil activating protein-78 (ENA-78) and growth-related gene alpha (GRO-α), as well the bone marrow microvascular density (MVD) in patients with MM at diagnosis and after treatment, in plateau phase. We also evaluated the relationship among them with other known growth factors involved in angiogenesis. METHODS: Serum levels of the ELR+ CXC chemokines: IL-8, ENA-78 and GRO-α as well as of the angiogenic factors: hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF) and tumor necrosis factor-α (TNF-α) were determined in 63 newly diagnosed MM patients, in 30 in plateau phase and in 20 healthy controls. Serum measurements of them were performed with commercially available kits for ELISA. Bone marrow biopsies were performed before and after treatment, in plateau phase, in order to determine MVD by staining vessels with anti-CD31. RESULTS: Serum concentrations of IL-8, ENA-78, GRO-α and TNF-α were significantly higher in the group of MM patients (44.5±25.3, 765±572.1, 186.5±129.1 and 4.2±2.8 pg/ml, respectively) in comparison to control group (27.3±6.4, 335.1±268.6, 112.5±76.1 and 1.3±0.8 pg/ml) (p<0.02 for GRO-α, p<0.001 for other cases). We also found that untreated patients had higher levels of IL-8, ENA-78, GRO-α than post treatment patients, but statistical significant difference was found only for IL-8 (48.36±30.93 pg/ml vs. 35.05±19.77 pg/ml, p<0.001). Furthermore IL-8, GRO-α, TNF-α, HGF and VEGF were significantly higher with increasing disease stage (p<0.001 in all cases). ENA-78 serum levels were higher in stage III than in stage I and II, but without statistical significance. Additionally we correlated each proinflammatory cytokine with well known angiogenic factors such as HGF, VEGF and TNF-α. A positive correlation was found between serum HGF and IL-8 and GRO-α (r=0.316 p<0.01, r=0.297 p<0.02, respectively). Similarly serum VEGF correlated with ENA-78 and GRO-α (r=0.323 p<0.01, r=0.469 p<0.001, respectively). In the pretreatment group of patients a positive correlation between bone marrow MVD and serum levels of GRO-α was found (r=0.304 p<0.01). There was a difference in survival times between patients with higher than median versus low IL-8, ENA-78 and GRO-α levels, but the differences could not reach statistical significance in either case. CONCLUSIONS: These findings support the hypothesis that ELR+ motif CXC chemokines, such as IL-8, ENA-78 and GRO-α correlate with angiogenic growth factors and may play a role in the progression of MM. Further studies are needed to determine their prognostic and predictive significance.

Endophthalmitis after cataract extraction: incidence, treatment, and outcome in Crete, Greece, during period 2000-2008.

PURPOSE: To report the incidence, microbial spectrum, and outcome of cataract operation related endophthalmitis cases from 2000 to 2008 in the Department of Ophthalmology, University Hospital of Heraklion, Crete. METHODS: Retrospective, observational case series collected from the files of the University Eye Clinic of Heraklion. RESULTS: From 2000 to 2008, 23 eyes of 23 patients with endophthalmitis after cataract surgery were reported. Vitreous specimens were obtained in all cases. Twelve were cultured positive, 8 with gram-positive bacteria, and 4 with gram-negative bacteria. Ten patients were treated medically, 13 surgically, and 2 finally underwent enucleation of the affected globe. Fourteen (60.8%) eyes of the total 23 managed in our hospital, achieved a final visual acuity of 1/10 or better and 9 lower than 1/10. Five eyes ended up with no light perception. CONCLUSIONS: We provide an overview of cataract operation related endophthalmitis cases managed in our clinic during the past 9 years.

Psychometric properties of the QLQ-C30 (version 3.0) in a sample of ambulatory Cretan cancer patients.

The aim of the present study was to test the psychometric properties of the Quality of Life Questionnaire (QLQ-C30, version 3.0) in a sample of ambulatory cancer patients, mostly low educated and coming from rural areas of the island of Crete. The sample consisted of 188 lung, breast and colorectal cancer patients. Their quality of life (QoL) has been evaluated twice: before and after the first therapeutic intervention. Alpha coefficients ranged from 0.88 to 0.98. Inter-scale correlations were more substantial between the physical, role and fatigue scales. Mean score differences between groups of patients with different performance status (PS) were statistically significant for most of the sub-scales. Instead the patients with stable PS after treatment showed worse functioning in five from the nine sub-scales. For those whose PS has deteriorated, their subjective evaluation indicated deterioration only for physical, role and social functioning. In this sample of mainly ambulatory cancer patients, the instrument has high coefficients of reliability and good clinical validity. However, the results related to its sensitivity are not very consistent. It has proven able to detect clinically significant changes after the therapeutic intervention only for the patients who deteriorated over time and for three specific dimensions of QoL: physical, role and social functioning.

Individual determinants of primary healthcare utilisation in Gaza Strip, Palestine.

OBJECTIVES: To examine the extent to which primary care patients are using the primary healthcare (PHC) services in Gaza Strip, Palestine, and to determine the factors that are associated with the use of these services. METHODS: Using Andersen's behavioural model, the authors interviewed 956 PHC attendees. Patients were questioned about predisposing factors: age, sex, marital status, education, work status, household size, life events (psychological and financial), perceived living conditions and health locus of control. Enabling factors included urbanisation and household income. Need factors included self-rated health. Healthy lifestyle was measured by two variables: smoking and physical activity. Outcome factors were measured by patients' satisfaction with PHC. RESULTS: The study revealed that the majority of interviewed patients (64.7%) reported high use (>3 times per 6 months) of PHC within the 6-month period before the interview. The main factors found to be associated with high use of PHC were older age, married and divorced/widowed status, perceived bad living conditions, not working, high level of income, poorly rated health status and current smoking habit. CONCLUSIONS: Gazean primary care patients are high users of PHC services. The increased use of these services is associated with the basic predisposing, enabling and needs factors and with the unique bad living conditions. Tobacco use was another aspect associated with high use of PHC. Effective health management, based on promoting a healthy lifestyle, is needed. The findings of this study can be used to improve health service planning and guide decision-makers towards healthcare resource allocation according to healthcare needs.

Prevention of post-operative nausea and vomiting in children--a prospective randomized double-blind study.

BACKGROUND/PURPOSE: Post-operative nausea and vomiting (PONV) are common complications related to surgery and anaesthesia. The aim of this study was to assess whether sevoflurane, with or without the use of an antiemetic such as ondansetron, increases or not the incidence of PONV in children. METHODS: One hundred and ten children, 2 months to 14 years undergoing inguinal hernia, hypospadias and penile deformity repair, were randomly allocated into one of two groups, according to whether they received ondansetron or placebo (47 vs. 63). Induction and maintenance of anaesthesia was with Sevoflurane in both groups. Regional anaesthesia was performed on all children (inguinal nerve, penile or caudal block). No opioids were used. In post-operative period, children were assessed for PONV, every 4 h for the first 24 h. RESULTS: Vomiting was very low in both groups (8 cases: 7.3%). No significant statistical difference of post-operative nausea (p = 0.296) and vomiting (p = 0.462) (Fisher's exact test) was found between the group that received ondansetron and the placebo group. CONCLUSION: We found that the use of ondansetron did not change the incidence of PONV, the avoidance of opioids and the adequate analgesia may contribute to this. Post-operative oral intake of liquid, (within the first 4 h), increases the risk for PONV.

Assessment of levels of organochlorine pesticides and their metabolites in the hair of a Greek rural human population.

We present the assessment of chronic exposure of the rural population of Helia Peloponnesus, Greece to banned organochlorine pesticides, hexachlorocyclohexane (HCH), and 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (DDT), using hair analysis. A total of 222 head hair samples were collected and analyzed for the presence of those organochlorine pesticides and their metabolites or isomers. Gas chromatography coupled to mass spectrometry was used to measure the levels of the pollutants. The median concentrations of alpha-HCH, hexachlorobenzene, lindane, ortho para 1,1-dichloro-2,2-bis-(4-chlorophenyl)ethylene (opDDE), para para 1,1-dichloro-2,2-bis(4-chlorophenyl)ethylene (ppDDE), ortho para 1,1-dichloro-2,2-bis(4-chlorophenyl)ethane (opDDD), para para 1,1-dichloro-2,2-bis(4-chlorophenyl)ethane (ppDDD) + ortho para 1,1,1-trichloro-2,2-bis(4-chlorophenyl)-ethane, and para para 1,1,1-trichloro-2,2-bis(4-chlorophenyl)-ethane were determined at 40.4, 19.7, 124.2, 6.2, 7.8, 73.1, 8.0, and 5.7 pg/mg. The median concentration of total HCHs and DDTs were 117.8 pg/mg and 9.4 pg/mg, respectively. The levels of total HCHs were much higher than the levels of DDTs in the hair samples of the studied population. This may be attributed to the presence of lindane, a pesticide officially banned in 2002. It is interesting to see that DDTs are still traced in samples despite their use being banned for more than three decades. There was no difference in the levels of the detected pesticides in hair sampled from men or women. The concentration of HCHs remains high and relatively stable across the age groups, suggesting constant exposure until very recently. The concentration of the total DDTs and the parent compound, pp-DDT presents a statistically significant decreasing trend across the age groups.

Serum levels of interleukin-15 and interleukin-10 and their correlation with proliferating cell nuclear antigen in multiple myeloma.

In order to determine prognostic factors characterizing multiple myeloma (MM) cell kinetics, bone marrow proliferative activity and serum Interleukin-10 (IL-10), and Interleukin-15 (IL-15) levels were measured in 40 newly diagnosed MM patients, compared with 10-age and sex-matched-healthy controls. Cell proliferation was evaluated by employing a monoclonal antibody directed against the proliferating cell nuclear antigen (PCNA), whereas IL-10 and IL-15 were measured with quantitative sandwich enzyme immunoassay methods. IL-15, IL-10 and PCNA were higher in the patient group than in controls (P<0.001). IL-10 levels, and PCNA increased significantly with increasing Durie-Salmon disease stage (I-III, P<0.002, and P=0.001, respectively). Serum IL-15 levels in MM stage III patients were elevated in comparison with stages I and II, the difference however, did not reach statistical significance. There was a significant positive correlation between serum IL-15 and IL-10 levels (r: 0.372, P<0.01), and between serum IL-10 and PCNA (r: 0.608, P<0.0001), as well as a positive correlation of serum IL-15 with PCNA, which marginally failed to reach statistical significance. Serum IL-15 levels are elevated in MM patients, increase with advancing stage, and correlate with Il-10 and PCNA. These proliferative factors may be useful in assessing disease progression in MM.

Factors affecting fracture healing after intramedullary nailing of the tibial diaphysis for closed and grade I open fractures.

As there is little information on the factors that influence fracture union following intramedullary nailing of the tibia we retrospectively investigated patient-, injury- and treatment-related factors in 161 patients with closed or grade I open fractures of the tibial diaphysis. The patients were reviewed until clinical and radiological evidence of union at a mean of 13.3 months (4 to 60). Multivariate statistical analysis using a Cox proportional hazards model showed that the risk of failure of union increased by 2.38 times for highly comminuted fractures, by 3.14 times when nail dynamisation was applied, and by 1.65 times when the locking screws failed. In fractures with no or only minimal comminution the risk of nonunion increased if the post-reduction gap was > or = 3 mm.

Levels of soluble forms of ICAM and VCAM in patients with myelodysplastic syndromes and their prognostic significance.

The aim of this study was to assess circulating soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and interleukin-1beta (IL-1beta) in myelodysplastic syndromes (MDS) in order to evaluate their clinical significance. Seventy patients with untreated MDS [21 refractory anemia (RA), nine RA with ringed sideroblasts (RARS), 17 RA with excess of blasts (RAEB), 11 RAEB in transformation (RAEBt), and 12 chronic myelomonocytic leukemia (CMML)] were included in this study. Serum levels of sICAM, sVCAM, and IL-1beta were determined at diagnosis using commercially available immunoassays. In addition, 15 healthy volunteers were studied as a control group. sICAM, sVCAM, and IL-1beta serum levels were significantly higher in MDS patients in comparison with the control group (P <0.001). Patients with CMML showed the highest sICAM, sVCAM, and IL-1beta levels in comparison with other MDS-related subtypes. Furthermore significantly elevated levels of the studied parameters were detected in high-risk MDS patients (RAEB, RAEB-t, and CMML) in comparison with low-risk MDS (RA and RARS). IL-1beta was strongly correlated both to sICAM and sVCAM. In conclusion we have provided evidence that increased sICAM and sVCAM serum levels are related to MDS severity.

Monitoring of pesticide residues in fresh peaches produced under conventional and integrated crop management cultivation.

The frequency and severity of crop protection product (pesticide) contamination of peaches grown conventionally were compared with those of peaches grown by integrated crop management (ICM). The peach samples (n = 150) were collected preharvest (June-August 2001) from both conventional (n = 55) and ICM (n = 95) cultivations from the Pella and Imathia districts of Macedonia, Northern Greece. The residue levels of selected insecticides, fungicides and acaricides in peach samples were determined by gas chromatography-mass spectrometry following solid-phase extraction. The concentrations of all detected pesticides were lower than the maximum residue limits (MRLs) in all peach samples grown with the ICM system (p<0.001). However, chlorpyrifos residues at levels higher than the MRLs were detected in four peach samples (i.e. 7% of the total samples) grown by the conventional system. Comparing the results for both cultivation methods with the reported average percentage (3.6%) of fruit samples with pesticide residues above the MRLs (European Union report for Greece in 2001), it was concluded that the initial implementation of the ICM in Greece was successful. The present study indicates that ICM cultivation has a higher efficiency in terms of product safety and quality. Furthermore, the results suggest that the application of conventional cultivation requires continuous monitoring of various crop protection product levels.

Expression of proliferating cell nuclear antigen (PCNA) in multiple myeloma: its relationship to bone marrow microvessel density and other factors of disease activity.

The expression of proliferating cell nuclear antigen (PCNA) was studied in plasma cells in bone marrow biopsies from patients with multiple myeloma (MM) using a double immunostaining method. In the same samples, microvessel density (MVD), after staining with anti-CD34 antibodies, was determined before and after chemotherapy. The correlation of PCNA expression and MVD with other myeloma parameters (clinical stage, bone marrow plasma cell infiltration and serum interleukin-6 (IL-6)) was also investigated. The study population included 51 newly diagnosed MM patients, 15 patients in plateau phase after treatment and 15 normal controls. Pretreatment mean +/- SE values of PCNA, MVD, plasma cell infiltration and serum IL-6 were significantly higher than post treatment values and controls. Pretreatment PCNA expression correlated significantly with bone marrow MVD (p<0.05) plasma cell infiltration (p<0.01) and IL-6 (p<0.01). These findings show that the proliferative activity of plasma cells is related to the angiogenic activity in the bone marrow of multiple myeloma patients. Both PCNA and MVD correlate with markers of disease activity thus may provide additional information when included in the initial evaluation of myeloma bone marrow biopsies.

Three-year study of fenthion and dimethoate pesticides in olive oil from organic and conventional cultivation.

Residues of fenthion and dimethoate pesticides were determined in organic and conventional olive oils by liquid-liquid and solid-phase extractions with subsequent gas chromatography and mass spectrometric analysis. The olive oil samples were collected from Crete during 1997-99. The average concentrations of fenthion in conventional olive oils were 0.1222, 0.145 and 0.1702 mg x kg(-1), and for dimethoate were 0.0226, 0.0264 and 0.0271 mg x kg(-1) for 1997, 1998 and 1999, respectively. The average concentrations of fenthion in organic olive oils were 0.0215, 0.0099 and 0.0035 mg x kg(-1) for 1997, 1998 and 1999, while for dimethoate they were 0.0098, 0.0038 and 0.0010 mg x kg(-1), respectively. All the olive oils contained residue levels lower than the maximum residue levels according to the FAO/WHO Codex Alimentarius. The organic olive oil contained significantly lower concentrations of the two pesticides. The levels of fenthion and dimethoate in organic olive oils exhibited a decreasing trend following the implementation of the new cultivation method. We propose procedures that should be established in the organic cultivation in order to maximize its effectiveness.

In vitro study of oxytetracycline adsorption on activated charcoal.

In vitro adsorption experiments simulating pH in gastric environment and using Langmuir isotherm, showed that 408 mg of oxytetracycline was adsorbed per gram of activated charcoal. Langmuir isotherm fitted adsorption data better than a Freundlich isotherm. Freundlich isotherm showed a specific adsorption capacity of 518 mg/g for activated charcoal. Both isotherm parameters indicated a strong oxytetracycline adsorption on activated charcoal in terms of quantity and binding strength. The results demonstrate that the concomitant use of oxytetracyline and activated charcoal should be avoided.

Deactivation of mycotoxins. I. An in vitro study of zearalenone adsorption on new polymeric adsorbents.

This study describes the elimination of zearalenone concentrations in vitro using two new polymeric forms of cross-linked polyvinylpyrrolidone (cryogels of cross-linked PVP). Adsorption of zearalenone was studied under isothermal conditions and simulating pH of intestinal environment. A Freundlich isotherm was used to describe the adsorption data obtained. The results showed significant decrease of zearalenone concentrations, ranging from 33.5-66.2% per 25 mg of polymer. Adsorption capacity (k) was estimated to be higher than that of previously tested adsorbents, including crospovidone. The data indicate the need to investigate structure peculiarities in order to improve mycotoxin deactivation procedures using PVP derivatives.

Acute poisonings and sudden deaths in Crete: a five-year review (1991-1996).

Fatal and non-fatal acute poisonings and other sudden deaths examined in the Toxicology Laboratory of University Hospital of Iraklion, Crete, from 1991 to 1996 mainly involved the abuse of drugs (heroin, flunitrazepam and other psychoactive substances), accidental poisonings or suicide attempts with pesticides (carbamates, organophosphates, paraquat), other chemicals (cyanide salts, paint thinner, chlorine), traffic accidents, drownings and violent deaths (gunshots). Many of the cases were related to poisonous gases or volatiles (carbon monoxide, methylbromide). Fatalities due to alcohol and methylene-dioxy-ethyl amphetamine were also examined. Amphetamine and alcohol-related deaths due to drowning were more recent. A significant number of cases were related to the accidental ingestion of alcohol, drugs or suicide attempts by children. Some of the cases were treated successfully in various Cretan hospitals, while others had fatal outcomes due to late hospital admission.