[Validity study on the certification and coding of underlying causes of death for the mortality statistic]. / Trafnosc wyboru przez lekarza wyjsciowej przyczyny zgonu i kodowania danych z kart zgonów.

The study was designed to assess the differences in the quality of certification and coding practices of underlying causes of death, which the mortality statistics is based upon. The mains focus of the study was the problem of proper selection of the underlying cause of death in various diseases. In the analysis the potential impact of medical experience of the physicians and the hospitalization of patients before the death have been taken in consideration. There were 479 death certificates chosen randomly out of all certificates filled in by 240 medical doctors in 1999 in Krakow. For each death certificate the available clinical case histories for deceased persons have been collected in order that a team of medical experts could formulate their independent opinion about the underlying cause of death. From comparisons of the underlying causes of death from the death certificates with those of experts, the indices of agreement have been calculated. The best overall agreement has been found for the neoplasmatic diseases (83.1%) and the lowest for the chest diseases (30.7%). For cardiovascular diseases the overall agreement was 65.5%, however in coronary heart disease it reached 74.0% and in cerebrovascular diseases 78.7%. Generally, the better agreement has been demonstrated if the additional information about the coexistent diseases or direct causes of the death has been mentioned in the death certificates as well. The longer period of hospitalization of subjects before death was related significantly with the higher agreement indices.

[Amanita phalloides poisoning--diagnosis, clinical course, treatment]. / Zatrucie muchomorem sromotnikowym--rozpoznawanie, klinika, leczenie.

This study presents a general review of current opinion on Amanita phalloides and other toxic Amanita species poisonings, clinical symptoms, elementary principles of mycological, clinical and laboratory diagnostics, and treatment. Early diagnosis, centralization of the treatment have been particularly emphasized.

[Acute, oral poisoning with hydrogen peroxide (concentrated peracetic acid) with neurologic sequelae]. / Ostre, doustne zatrucie perhydrolem (stezonym nadtlenkiem wodoru) z nastepstwami neurologicznymi.

The case of accidental, acute oral poisoning with concentrated hydrogen peroxide with peracetic acid components of disinfectant using in food industry (Steridial P) is presented. Neurological sequelae as a result of gas embolisation and supportive and symptomatic treatment are described.

[Suicidal self poisoning with disulfiram in a 15-year old boy with resulting encephalopathy]. / Samobójcze ostre zatrucie disulfiramem u 15-letniego chlopca z nastepowa encefalopatia.

Acute intentional overdoses of disulfiram (app. 30 g) is reported in 15-years-old boy. The neurological disturbances as nystagmus, coma, seizures and than impairment of memory and perception were dominated in the clinical picture. During MRI examination the areas of different signal from corpus callosum were detected which can be referred to focus of demyelinisation. The patient recovered and was discharged from the hospital after 30 days. Neuropsychological examinations have suggested dysfunction of CNS. The control MRI examination 90 days later, did not reveal any pathological changes in the brain.

[Psychiatric disorders during acute tetraethyl lead poisoning in a woman with hyperthyroidism]. / Zaburzenia psychiczne w przebiegu ostrego zatrucia tetraetylkiem olowiu u kobiety z nadczynnoscia tarczycy.

We described clinical course of tetraethyl lead poisoning of 21 years old woman with hyperthyroidism. Psychotic symptoms dominated and they disappeared after 4 weeks lasting treatment. Therapy is discussed, including toxicologic, psychiatric and endocrynologic treatment. The basic elements of differential diagnosis in toxic and endocrinologic psychosis are discussed.

[Acute suicidal poisoning with Dapsone]. / Ostre samobójcze zatrucie Dapsonem.

Course of disease and treatment of 27-years old female patient suffering from celiac disease, who took Dapsone on suicidal purpose in a dose 23 times over maximal daily dose. Methemoglobinemia and hemolysis with anemia typical for this poisoning have been observed. In the first period after intoxication hypokalemia of unknown reason and shedding of hair 7 weeks after intoxication have been noticed. It is remarkable that methemoglobinemia maintained until 8 day after intoxication, in spite of intensive treatment with reducers and blood transfusions. That indicates tissular accumulation of Dapsone. Patient treated with Dapsone shouldn't possess the quantity of this drug that-taken as a single dose-can put him at risk.

[The responsibility of the emergency service physician and patient consent to treatment and hospitalization]. / Odpowiedzialnosc lekarza placówek naglej pomocy a zgoda pacjenta na leczenie i hospitalizacje.

Amenability of emergency service physician for the treatment given without patient consent has been presented in the study. Depending on circumstances it can be penal, civil, disciplinary and professional responsibility. The study has been annotated with current legal and ethical rules, which should be not only commonly known to physicians but also respected to avoid legal consequences.

[State and local administration, alcoholism and narcotic addiction]. / Administracja rzadowa i samorzad terytorialny a problemy alkoholizmu i narkomanii.

An important social and medical problem of alcoholism and drug addiction in Poland is presented. Alcoholism is a serious danger for individuals, families and society because it is so common and due to its consequences. Described is a three stage system of preventing measures being undertaken by state and local administration together with local community institutions. By the example of the activities performed by the plenipotentiary of the voivode of Krakow a duties of such institutions are presented. The special role is played by the high medical personnel according to the prevention and early detection of potential threats.

[Acute oral poisoning with isopropyl alcohol in alcoholics]. / Ostre doustne zatrucie alkoholem izopropylowym u osoby uzaleznionej od alkoholu etylowego.

The symptoms and clinical course of repeated poisonings with isopropyl alcohol in ethanol addicted 43-years old man is presented in the study. The blood and urine concentrations of isopropanol and acetone and also the blood ethanol concentration are given. The biological half-life of isopropanol calculated for the first 12 hours from admission to the Clinic was 6.9 hours. The biological half-life of acetone in the first 6 hours of hospitalisation was 5 hours, and then a considerable slowing down up to 29 hours was noted. The clinical symptoms, similar to ethanol poisoning, including strongly manifested catatonia and ketonuria without metabolic acidosis indicate the isopropanol intoxication. Hypokalemia should to be taken into consideration in treatment of isopropanol poisoning. An intravenous bicarbonates should be administered carefully e.g. when rhabdomyolysis occur.

Acute poisonings in the course of drug addiction: chemicotoxicological diagnostics.

A demand for a quick and reliable diagnostics of acute and chronic poisonings with drugs of abuse, monitoring of the treatment of drug abusers and controlling their abstinence lead to a search for the most useful diagnostic methods for clinical aims and certification. Our observations concerning the importance of toxicological investigation, particularly the use of Triage rapid immunoassay, in the diagnostics of acute poisonings and the abstinence control of dependent people were presented. Urine of 418 poisoned people and 7 "detoxificated' patients treated at the Department of Toxicology in Kraków in the years 1991-1995 was examined, and in 54 cases Triage method was used (seven drugs of abuse were determined: amphetamine, barbiturates, benzodiazepines, cocaine, methadone, opiates and tetrahydrocannabinoids), which was later confirmed using the Fluorescence Polarisation immunoassay, measured with the Vitalab Eclair. An increase in number of admitted patients to the Department of Toxicology was noted and the need for reliable diagnostics concerning the increasing number of cases in which inconsistency of the drug declared in the interview with the toxicological findings was stated. Triage method used in the examinations proved to be very useful for clinical diagnostics in quick determination of drugs of abuse in urine. The result should be confirmed using another, preferential method for the poison found in biological material.

[Sensitivity of exercise echocardiography, electrocardiographic exercise test and 24-hour ekg monitoring in diagnosing and evaluating the efficacy of coronary disease treatment]. / Znaczenie wysilkowej echokardiografii, elektrokardiograficznej proby wysilkowej i 24-godzinnego monitorowania EKG w rozpoznaniu i ocenie skutecznosci leczenia choroby wiencowej.

To test the sensitivity and specificity of noninvasive tests for detecting myocardial ischemia, 78 patients undergoing cardiac catheterisation for suspected coronary artery disease (CAD) were studied in prospective blinded manner with exercise echocardiography (EE), ecg stress test (ET) and 24-hour Holter monitoring for analysis of ST-segment changes (HM). All noninvasive tests were repeated after one year follow-up period. Exercise was performed in a supine position using a bicycle ergometer. Real time 2-DE examinations were performed in the left lateral position: at rest, at the peak of exercise and immediately after exercise testing. The sensitivity and specificity of EE, ET and HM for detection of CAD were: 76%, 92%; 90%, 48%; and 80%, 71% respectively. In a group of 48 pts with the narrowing of coronary artery (CA) < 50%, the follow-up EE was negative in 45. In a group of 30 pts with significant narrowing of CA, 10 were asymptomatic within one year after PTCA or CABG; in 9 of them the follow-up EE as well as ET were negative. HM less correlated with clinical course in asymptomatic subjects: in 4 patients it was negative and in 6 - positive. The reminding 20 patients with CAD treated medically, with PTCA or CABG were symptomatic after one year. The follow-up EE, ET and HM studies were positive in 17, 19 and 17 cases respectively. We conclude that sensitivity of EE in diagnosis of CAD is comparable to ET and HM, but its specificity is higher.(ABSTRACT TRUNCATED AT 250 WORDS)

[Plasmapheresis in the treatment of hepatic coma]. / Plazmafereza w leczeniu spiaczki watrobowej.

Fourteen patients, including 6 with viral hepatitis B and 8 with liver cirrhosis were treated with plasmapheresis for hepatic coma. Altogether 29 plasmaphereses were carried out. Complete recovery was achieved in one patient with viral hepatitis B and in 3 patients with liver cirrhosis. Plasmapheresis should be performed in patients with severe lesions to the liver. Classification of patients to the treatment should include clinical examination, biochemical and enzymatic tests, and evaluation of liver reserve with isotope hepatography. In case of the acute poisoning with hepatotoxic agents indications to plasmapheresis should be evaluated from the toxicologic point of view.

[Clinical and toxicologic problems related to acute poisoning with chromium]. / Zagadnienie kliniczne i toksykologiczne ostrych zatruc chromem.

Clinical course and toxicological findings in 18 patients intoxicated with ingested chromium salts are presented. Seventeen of these patients ingested potassium and sodium dichromate while the remaining patient--chromic acid. The first stage of 6-valent chromium is characterized by its irritating effect on the gastro-intestinal mucous membrane manifested by diarrhoea, vomiting often with blood, leading to severe water-electrolyte disorders, acidosis and shock. Lesions to kidneys, liver and myocardium may develop in the next stage. Probably endothelium is also in injured with resulting increase in its permeability. Acute renal failure is not seen even with high levels of chromium in the urine provided, that the recovery from the shock is prompt, and adequate diuresis induced with mannitol and/or furosemide is maintained. All patients with blood chromium concentration exceeding 1 mg/100 g died. This level is of prognostic and diagnostic value indicating an ingestion and absorption of the high doses of this metal.

[Chemical poisoning in suicide attempts by the elderly]. / Zatrucia chemiczne w próbach samobójczych ludzi starych.

The problem of suicidal attempts in which the chemical substances are used is very important for clinical toxicology. Suicide subjects make up 61 to 68% of all hospitalized patients with acute poisoning in Toxicological Centers in Poland. And mainly the young not the old are involved in these suicidal attempts. In the Toxicological Clinic in Kraków in period 1980-1986 138 patients (81 women and 57 men) above the age of 60 residing in Province of Kraków were hospitalized since while committing suicide by chemical substances, they got poisoned. Most of the patients (90%) were poisoned by a single drug or mixed ones; frequently by Reladorm (31.5%), by benzodiazepines alone (31%) and by barbiturates (21%), less frequently by chlorpromazine drugs, tricyclic antidepressants and cardiac drugs which were only concomitant toxins. The rest of the studied patients (10%) were poisoned with organic solvents (4 patients), hydrochloric acid (4 patients), organophosphate pesticides (3 patients). In single cases it was seed dressing T (thiuram), carbon monoxide or ethanol poisoning. The case of ethyl alcohol poisoning was discussed and the patient who ingested it commit suicide died. 14 patients died (10%) and the lowest mortality rate was in 61-70-year--old patients and it was evidently higher for the younger patients. The causes of the patients' death as well as psychological and psychiatric aspect of the suicides were discussed. Some conclusions concerning prophylaxis of suicidal poisonings in the elderly were drawn.

[Ultrasonographic examinations of the liver in poisoning with Amanita Phalloides]. / Badania ultrasonograficzne watroby w zatruciu muchomorem sromotnikowym.

11 persons poisoned by Amanita phalloides with a clinical picture of the Amanita phalloides syndrome of various gravity were subjected to ultrasonographic tests of the liver. A group of the sick had control test after they had been cured. In ultrasonographic pictures the size of the organ, the changes of the structure and the vascular picture and the dynamics of the changes in connection with the clinical picture and the results of the biochemical tests were estimated. The ultrasonographic changes are not symptomatic for Amanita phalloides poisoning, but similarly to scintigraphic test of the liver they may serve as an exemplification of the morphological changes of the organ and the estimation of the dynamics of changes. Ultrasonographic tests, in case of Amanita phalloides poisoning, should be treated as complementary, providing an insight into the liver structure, without being detrimental to the patient.