[Transient and permanent damage to the heart in the course of acute poisoning]. / Przemijajace i trwale uszkodzenia serca w przebiegu ostrych zatruc.

Transient and permanent myocardial damage is a vital element of toxicological practice. This applies both to poisonings in which heart injury is typical and to those in which it is only a rare complication. Vital signs of poisoned patients, especially unconscious ones, must be carefully monitored, because the consequences of late diagnosis or improper treatment can be potentially fatal. The following paper discusses the mechanisms leading to heart damage in the course of acute poisoning. It also presents clinical symptoms, treatment options and prognosis for myocardial injury in selected poisonings.

[Tako-tsubo cardiomyopathy in the course of carbon monoxide poisoning]. / Kardiomiopatia tako-tsubo w przebiegu zatrucia tlenkiem wegla.

Tako-tsubo cardiomyopathy is a clinical syndrome induced by a strong mental or physical stress, characterized by a transient hypokinesia, akinesia or dyskinesia middle segments of the left ventricle and apical, with associated electrocardiographic changes of ST-T segment like in acute coronary syndrome, with no significant changes in coronary arteries in coronary angiography. Tako-tsubo cardiomyopathy is mainly found in women in the sixth and seventh decade of life and represents 1-2% of cases originally diagnosed as acute coronary syndrome. We present a case of tako-tsubo syndrome in the course of carbon monoxide poisoning in a 56-year-old patient, with a positive history of ischemic heart disease and hypertension. Moreover, the reasons for its occurrence were considered based on clinical course, laboratory tests and imaging, and available literature.

[Noncardiogenic pulmonary edema in the course of poisoning with clozapine, ketoprofen and thiethylperazine]. / Niekardiogenny obrzek pluc w przebiegu zatrucia klozapina, ketoprofenem i tietylperazyna.

Pulmonary edema is a severe, potentially fatal clinical condition. It happens, when interstitial fluid is accumulating in the alveoli, impeding proper gas exchange. Typically we distinguish cardiogenic and noncardiogenic pulmonary edema. The article describes the case of severe pulmonary edema, which occurred in a young woman, free of cardiac diseases, about 30 hours after a suicidal drug poisoning (clozapine, ketoprofen, thiethylperazine). Both clozapine and ketoprofen intoxication, may be severe. Complications in these poisonings affect not only the central nervous system, but also the circulatory or respiratory system and may even occur several hours after the overdose of these drugs. The study considered the causes and possible mechanisms of pulmonary edema in poisoning with these drugs.

[Is it possible to survive metabolic acidosis with pH measure below 6.8? A study of two cases of inedible alcohol intoxication]. / Czy mozliwe jest przezycie kwasicy metabolicznej o wartosci pH ponizej 6,8? Opis 2 przypadków klinicznych zatrucia alkoholami niespozywczymi.

26 of serious inedible alcohol (ethylene glycol and methanol) intoxications have been observed in Lublin Regional Center of Clinical Toxicology during 2010/2011 (18 mounths). As a result of such intoxications, metabolic acidosis and acute renal failure and other organs injury develop. The writings inform that it is possible to survive a pH spectrum between 6.8 and 7.8, whereas beyond these values protein denaturation and death proceed. The paper presents two cases of intoxication with ethylene glycol and ethylene glycol, methanol together where the lowest pH values in capillary blood were recorded below 6.8. The first case is of a male, 45, who was diagnosed glycol concentration at 283.3 mg/dl, with the lowest pH value obtained in the gasometric examination of capillary blood at 6.712. The other case is of another male, 54, who had probably drunk condenser liquid. Ethylene glycol and methanol's concentration were 535 mg/dl and 37.5 mg/dl correspondingly, whereas the lowest capillary blood pH value was recorded at 6.745. Both men had been addicted to alcohol for many years. The treatment demanded multiple hemodialyses, respiratory therapy, catecholamine intravenous injections as well as intensive pharmacological treatment resulting from multi-organ complications. The intoxication in either case was non-lethal.

[Cost of anaesthesia at the university hospital]. / Ocena kosztów zwiazanych z dzialalnoscia anestezjologiczna w akademivkim szpitalu klinikcznym.

BACKGROUND: The costs of anaesthesia in Polish hospitals are usually calculated as a percentage of the cost of the surgical procedure, or as a percentage of the total cost of the operating theatre. These methods cannot be accurate, since they do not take into consideration, the specifics of anaesthesia. Therefore, a new method of calculation, based of the actual use of materials and manpower, has been introduced in our institution. METHODS: Anaesthesia procedures were divided into nine categories, according to risk of anaesthesia, type of surgery, type of anaesthesia, and working hours of the anaesthetic personnel. Each category was priced in points which expressed the actual value of the service provided, and the resulting totals were allocated to surgical specialties. RESULTS: The costs of anaesthesia calculated by the new method differed markedly from previous calculations. The number of anaesthetics between 2008 and 2010 increased by 20%, while the cumulative costs of anaesthesia rose by only 13%, when compared to the previous method of calculation. Changes in anaesthesia costs, in various surgical specialties, varied from -49% to +65%, and were not related to the number of procedures. CONCLUSION: The new scoring system made it possible to calculate actual anaesthesia costs in various surgical specialties. It is logical and practical and merits recommendation.

High resolution ultrasonography for imaging metacarpophalangeal joints.

The purpose of the study was to examine the possibilities of high resolution US to visualize and diagnose the changes within the fissures of hand metacarpophalangeal joints and to assess the dimensions of metacarpophalangeal joints in healthy people and selected diseases. The study involved 44 individuals subjected to ultrasound examinations of the hands. The group included 35 healthy right-handed persons (22 women and 13 men), aged 21-53 (average - 33), 7 right-handed patients with rheumatoid arthritis (RA) (5 women and 2 men), aged 41-73 (average - 54) and 2 right-handed men treated for acromegaly, aged 43 and 58. The Logic 500 ultrasonograph (GE) was used. The images of metacarpophalangeal joints of both hands in the dorsal transverse and longitudinal projections were performed using the broad-band linear head with the frequency of 8.5-11 MHz. The analysis included 880 measurements of the metacarpophalangeal joints. The results were presented using the metacarpophalangeal joints of the 1st and 3rd fingers. The results in men and women, healthy and ill individuals were compared. In the authors' opinion high resolution US is a valuable method of imaging the anatomical structures of metacarpophalangeal joints, which may be used to evaluate morphological changes and to estimate the degree of joint destruction in some diseases.