[Some aspects of suicide in the years 1980-1996]. / Niektóre aspekty zgonów samobójczych w latach 1980-1996.

The reduction of suicide death index in 1981 year and 1989 year, that is in the period of temporary and definitive "Solidarity" victory confirms Emile Durkheim theory that revolution processes increase social integration and prevent suicide decisions. In the years 1991-1994 the number of suicide deaths in Poland was distinctly lower than in other countries of the Soviet Block and republics of the Soviet Union.

[Significant periodical fluctuation of insulin requirement in patients with type 2 diabetes]. / Znaczne okresowe wahania zapotrzebowania na insuline u chorych na cukrzyce typu 2.

We have described three physicians aged 65-70 years, who had noticed during their insulintherapy significant, periodically recurrent variations of insulin requirement (max. 50 i.u./24h vs 25 i.u./24h) in the periods of 4-16 weeks. They had been characterized by similar diet and physical activity, stable normal body mass (av. BMI 24.6) and normal glycosylated hemoglobin (av. HbA1c 5.9%). The hypothesis was put forward that the cause of this phenomenon may be periodical changes in the incretin system activity or increased proliferation of pancreatic beta cells leading to decrease of insulin requirement.

[Mild clinical course of left ventricular pseudoaneurysm]. / Tetniak rzekomy lewej komory serca o lagodnym przebiegu klinicznym.

Left ventricular pseudoaneurysm from myocardial infarction is rare but is associated with a high risk of rapid enlargement and rupture. This report describes a 57 year old woman with left ventricular pseudoaneurysm and delayed surgical repair. Seven weeks after myocardial infarction control transthoracic echocardiography revealed a inferolateral left ventricular pseudoaneurysm. Early surgical intervention was recommended but the patient refused hospitalization and surgical repair and continued every day home activity. The symptoms and signs were so mild that she was qualified to 1st class of NYHA classification and 1st class of CCS classification. Six weeks later-ventriculography confirmed the primary diagnosis. During heart surgery the pseudoaneurysm was incised, its fibrous wall with thrombus was resected and the ruptured left ventricular myocardium was satured. She had an uneventful postoperative course. Definitive diagnosis of the pseudoaneurysm was confirmed by histopathological evaluation of the excised left ventricular wall.

[Diabetes and road traffic collisions]. / Cukrzyca a kolizje w ruchu drogowym.

Insulin-treated diabetes influences motor vehicle driving mainly through the possibility to induce hypoglycemia in patients. However, there has never been any consistent evidence to suggest that patients with insulin-treated diabetes cause significantly more accidents than the general population. Diabetes and its complications have very various individual courses in patients, because of that candidates for driver's license should always be qualified individually. Drivers with diabetes complications, especially the elderly, quite often themselves limit driving. The programme facilitating the diagnosis of early hypoglycemic symptoms--Blood Glucose Awareness Training--decreases road traffic collision number.

[Weak anti-inflammatory effects of acetaminophen are related with its free radicals scavenger activity]. / Slabe wlasciwosci przeciwzapalne acetaminofenu wynikaja z jego dzialania jako zmiatacza wolnych rodników.

The main target of acetaminophen application is bifunctional enzyme--prostaglandin endoperoxide H2 synthase (PGHS)--which has cyclo-oxygenase and peroxidase activities and synthesizes initial intermediates in prostanoid synthesis. The reaction catalyzed by PGHS is radical-based and it is initiated and then maintained by the constant presence of peroxides especially peroxynitrate, which generate so-called "peroxide tone" in the enzyme surrounding. Currently it is known that inhibitory effect of acetaminophen on PGHS activity is directly connected with the elimination of "peroxide tone". High concentrations of reactive compounds (e.g. peroxynitrate and lipid peroxides)--produced by cellular defending mechanism at inflammatory sites--significantly decrease inhibitory impact of acetaminophen on PGHS activity. Such observation allows explanation of weak antiinflammatory effect of acetaminophen together with its strong analgesic and antipyretic properties.

[Hypercholesterolaemia among patients of the cardiology ward of a Regional Hospital in Wejherowo]. / Hipercholesterolemia wsród pacjentów oddzialu i Przychodni Kardiologicznej Szpitala Specjalistycznego w Wejherowie.

The strong positive relationship between cholesterolaemia and ischaemic heart disease is unquestioned and comes from several lines of evidence. In this paper results of questionnaire studies concerning cholesterolemia performed among patients of the Cardiology Ward of a Regional Hospital in Wejherowo are presented.

[Energy metabolism in the failing heart]. / Metabolizm energetyczny niewydolnego serca.

Daily heart consumption of energy (about 6 kg of ATP) exceeds significantly energy consumption of other organs. Deprivation of energy is considered as one of the main factors in development of heart failure. Currently available research methods permit not only to evaluate more precisely the role of impaired energy metabolism in the heart failure, but also give a hope for the future metabolic therapy.

[Strategic preparedness of selected hospitals to act during massive chemical disasters]. / Strategiczne przygotowanie wybranych szpitali do dzialan w warunkach masowych skaien chemicznych.

The aim of our study was the evaluation of strategic preparedness of twelve hospitals in Kraków, Warsaw and the Triple City to give aid during massive chemical accidents. The study was carried on 146 persons, including 9 managers, 31 ward heads, 75 assistants, and 31 ward nurses. In statistical analysis the generalized linear model extended by random factors, particularly the Poisson's regression has been used. In any of the investigated hospitals, there were no plans regarding of action in case of chemical accidents. The knowledge about sources of possible contamination as well as environment threats were insufficient. The majority of the medical staff did not know their role as well as the role of their hospitals in case of a chemical accident. There is an urgent need for courses about the procedures which should be used during chemical accidents. The lack of hospital preparedness to act during chemical disasters in the big cities suggests that a similar situation is common in other such medical units all over the country. Further investigations, especially in the hospitals which are placed near the potentially dangerous factories, should be carried on in the near future.

[Logistic preparedness of chosen urban agglomeration hospitals to act during massive chemical disasters]. / Logistyczne przygotowanie szpitali w wybranych aglomeracjach miejskich do dzialan w warunkach masowych skaizen chemicznych.

Twelve hospitals--five form Warsaw, three from Kraków, and four from Gdansk and Gdynia were randomized for the study. The logistic preparedness of hospitals during massive chemical accidents has been investigated. There were 146 probands (9 managers, 31 ward heads, 75 assistants and 31 ward nurses) included in the study. In statistical analysis the generalized linear model extended by random factors, particularly the Poisson's regression has been used. No hospital in the three big cities in the country was prepared for any logistic action in case of massive chemical disaster. There were no stationary and mobile decontamination units in the investigated hospitals. There was no individual protective equipment in any of the analyzed hospitals. There were serious deficits in assortment and amount of antidotes which can be used in the treatment of contaminated patients. As much as 97.2% of respondents pointed the poison information centers as a main source of information in case of chemical accidents.

[Essential preparedness of physician to act during massive chemical disasters]. / Merytoryczne przygotowanie lekarzy do dzialan w warunkach masowych skazen chemicznych.

The aim of the study was the evaluation of some aspects of doctors knowledge about the treatment in case of massive chemical accidents. The study was conducted in twelve hospitals in Kraków, Warsaw, and the Triple City. There were 106 doctors (31 ward heads and 75 assistants) included in the study. The questions contained some aspects of: external decontamination, the usage of 0.5% of sodium hypochlorite, the knowledge about the use of selected antidotes and the symptoms of chosen toxidromes. In statistical analysis the generalized linear model extended by random factors, particularly the Poisson's regression was used. The results confirm, that the medical staff is not well prepared to take an effective action in case of a chemical contamination. The essential knowledge of the medical staff in all investigated aspects of chemical safety has been found out to be not satisfactory. There is an urgent need for medical staff to undergo theoretical and practical courses about toxicity of major chemicals. The clinical toxicologists should be asked to prepare up-to-date, advanced methods and regulations for life support in case of heavy chemical accidents.

[Patients with alcohol problem in the Emergency Department of Medical University of Gdansk]. / Pacjenci z problemem alkoholowym w praktyce Klinicznego Oddzialu Ratunkowego Akademii Medycznej w Gdansku.

Alcohol misuse are severe financial burden for health care system in Poland. AUDIT and CAGE are two questionnaires used for diagnosis of alcohol abuse. We analyzed the incidence of alcohol problem among emergency unit's patients and correlation of this phenomenon with the reason of admittance to the hospital. 30% patients of Clinical Hospital Emergency Unit of Gdansk misuse alcohol. Injuries and acute intoxications were considerably more frequent reason of attendances to emergency unit in population of patients with drinking problem. AUDIT questionnaire is more effective and sensitive diagnostic instrument comparing to CAGE and may be useful for identification for both, addicted and misusing alcohol patients.

[The assessment of albumin liver dialysis--MARS efficacy in the treatment of Amanita phalloides poisoning]. / Ocena skutecznosci albuminowej dializy watroby--MARS w terapii zatruc muchomorem sromotnikowym.

Fourteen patients were included to the albumin dialysis--MARS in the Clinic of Internal Medicine Geriatry and Clinical Toxicology in the years 2004-2006 because of acute intoxication with Amanita phalloides. The 26 procedures were done. Ten patients recovered, one was transplanted and three patients at the age from 68 to 79 (average 72.6) years died because of acute liver failure (21.4% cases). All deceased patients had significant higher plasma bilirubin level and INR in compare to other probants. The procedures of albumin dialysis caused significant lowering of blood glucose level, red blood cells and platelets, but without the need for intervention.

[An assessment of cigarette smoking, with the usage of cotinine level, on life satisfaction in patients with coronary heart disease]. / Wplyw palenia tytoniu, ocenianego na podstawie oznaczenia kotyniny, na satysfakcje z zycia chorych z choroba wiencowa.

The aim of the study was to evaluate the impact of smoking, verified by the measurement of cotinine levels, on life satisfaction of patients with coronary artery disease. The questionnaire was answered by 36 patients (26 men and 10 women) aged from 48 to 7.6 (mean 63.5) years. The questions regarded the current attitude toward smoking, subjective self-assessment of health and life satisfaction while smoking and after cessation. Cantril's ladder has been used among others to assess life satisfaction. In order to verify the answers regarding current smoking cotinine (nicotine metabolite) serum, urine and saliva levels have been measured. There were 38.8% of current smokers in the studied group of patients after PTCA. The fact of current smoking was negated by 19.4% of smokers during medical exam. Objective verification of smoking is necessary in questionnaire studies on tobacco consumption. Measurement of cotinine in body fluids (serum, urine, saliva) may be useful in these cases. After cessation of smoking 93.9% respondents reported major subjective improvement in self-assessment of health. 54.5% of smokers admitted having been ashamed of the habit, and 60.6% the feeling of disturbing others while smoking. The increase of general life satisfaction measured by Cantril's ladder was observed in 94.7% of responders after cessation of smoking.

[Hazard for human health and life by unintentional use of synthetic sibutramine, which was sold as Chinese herbal product "meizitanc"]. / Zagroienie dla zdrowia i zycia ludzkiego przez nieswiadome zastosowanie syntetycznej sibutraminy, sprzedawanej jako chinski preparat ziolowy "meizitanc".

UNLABELLED: Problem of adulteration of herbal medicines with synthetic drugs is getting a common and dangerous phenomenon in Poland. The purpose of this study was the qualitative estimation of content of the Chinese herbal medicine for slimming "Meizitanc" as well as the estimation of hazard for human health and life. Twenty herbal packages which were secured by police in the 2006 year were investigated. The main ingredient of herbal medicine "Meizitanc" was sibutramine. The average mass of sibutramine hydrochloride in the "Meizitanc" capsule was about 10 mg. Additionally the trace amount of xylene and a starch were detected in the capsules. The presence of mentioned above substances were confirmed by different analytical methods like: gas chromatography with mass spectrometry GC/MS, thin layer chromatography TLC, high-pressure liquid chromatography HPLC/UV-DAD and infrared spectrometry IR. There were not determined any herbal-originated substances, which were mentioned on the packages. It was not found any pharmacologically active substance in one of the twenty examined packages. CONCLUSIONS: The medicine containing sibutramine should be used under the strict medical control. For safety of the patients all herbal products should be buy from authorized her

[Acute intoxication with zaleplon--a case report]. / Ostre zatrucie zaleplonem--opis przypadku.

UNLABELLED: There has been little data in the medical literature about intoxication with a new hypnotic agent zaleplon. The zaleplon, chemically N-[3-(3-cyanopyrazolo[1,5-a]pyrimidin-7-yl)phenyl]-N-ethylacetamid, is a selective agonist of the benzodiazepine omega 1 receptor subtype. The case of a 15-year-old female who eat 60 mg of zaleplon (1.2 mg/kg) because of suicidal attempt was described. At the admission to the hospital the somnolence, blurred speech, slowdown, ataxia, tachycardia and hypokalaemia were observed. The child was treated symptomatically, and discharged from the hospital for further psychologic treatment after 36 hours. CONCLUSIONS: Acute intoxication with zaleplon had mild clinical course. The signs of intoxications were drowsiness, blurred speech, ataxia, tachycardia, dizziness, confusion and vomiting. The described case required only symptomatic treatment.

[Tiagabine overdose--report of two cases]. / Ostre zatrucia tiagabina--opis dwóch przypadków.

UNLABELLED: Tiagabine is a derivative of nipecotinic acid used in the therapy of partial seizures, partial seizures with secondary generalization, stress disorder, psychosis and cocaine dependence. The pharmacologic effect of the drug is achieved by inhibition of reuptake of gamma aminobutyric acid (GABA) into glial cells and neurons, without permanent increase in whole brain GABA concentration. Symptoms of acute tiagabine overdose include seizures, coma, respiratory depression ' and less often dystonias, involuntary movements, somnolence, agitation, tachycardia and increase or decrease of blood pressure. Two cases of acute tiagabine overdose have been described in the paper presenting with partial and generalized seizures which were managed with benzodiazepines. CONCLUSIONS: The onset of symptoms of acute tiagabine overdose is rapid with resolution within first 24 hours from exposure. Acute tiagabine poisoning may present with a wide variety of neurological symptoms. Administration of benzodiazepines may improve the outcome of overdose.

[Acute intoxication with clonidine--a case report]. / Ostre zatrucie klonidyna--opis przypadku.

The case of a 24-year-old female who ingested 45 tablets of clonidine (Iporel á 0.075 mg) in the total dose of 3,375 mg in suicidal attempt was described. At the admission to the hospital the patient had complained of drowsiness and weakness. She was conscious but somnolent. Minimal blood pressure was 90/50 mmHg. The patient was treated with gastric lavage and crystalloids infusion. During two days of observation the symptoms were rapidly retreated.

A cocaine-associated quadriplegia and motor aphasia after first use of cocaine.

UNLABELLED: A 31-year-old female who have snorted one "line" of cocaine hydrochloride (approximately 35 mg), for the first time in her life, was admitted to the hospital because of acute onset of right hemiplegia and left hemiparesis evolving into quadriplegia. Motor aphasia, right eye-ball divergent strabismus and right mouth recess lowering were also observed. CONCLUSIONS: A first time mucosal administration of cocaine hydrochloride even in low dose can cause severe neurological complications like quadriplegia and aphasia. Cocaine-associated stroke can be a diagnostic problem in the emergency room. Unconscious patients or those with acute onset of neurological disorders can form a real diagnostic challenge, especially when there is no evidence of previous drug taking.

[Drug-induced liver failure caused by thiamazole and methimazole--a case report]. / Polekowe uszkodzenie watroby po tiamazolu i metimazolu opis przypadku.

UNLABELLED: Drug-induced liver injury might be responsible for 1 of 600 to 3500 of all hospital admissions. About 2-3% of all drug adverse effects may be connected with the liver. There could be pure injury of heaptic cells or impairment of hepatocellular bile secretion. In our case there was cholestatic liver injury after the use of thiamazole with the complete regression after the discontinuation of the drug. For two years' the patient was treated with methyltiouracyl without any side effects. After 19 years, because of thyreotoxicosis, the methimazole was used. The acute cholestatic liver injury with the high serum bilirubin level (41.4 mg/dl) was observed. Despite the discontinuation of the drug the patient was deceased. CONCLUSIONS: There are possible cross reactions among imidazolines in patients who are predispose to develop drug-induced liver failure. The doctors should pay much more attention to possible drug side effects.

[Oral intoxication with xylene--a case report]. / Doustne zatrucie ksylenem--opis przypadku.

UNLABELLED: A case of a suicidal oral exposure to xylene has been described. A 33 year-old female ingested 300-500 ml of xylene 2.5 hours before admission to the hospital. Hypotonia, metabolic acidosis, diarrhea and moderate, transient dysphagia were observed. Concentrations of xylene, toluene and ethylbenzene in blood at admission were 11.7; 2.9 and 0.18 mg/l respectively and 1.1; 0.33 and 0 mg/l after 24 hours after therapy. CONCLUSIONS: The course of acute xylene intoxication in the described case was relatively uneventful despite high blood concentration of xylene. Further study is necessary to establish the potentially lethal blood concentration of xylene.