Drugs of abuse--an analysis based on cases from the Kraków Department of Clinical Toxicology of Jagiellonian University College of Medicine in 1997-2000.

The aim of the study was to present the frequency of acute drug overdosing by dependent patients in the years 1997, 1998, 1999 and 2000, and to compare the numbers of poisoned addicts suffering withdrawal syndrome and seeking detoxification. The analysis includes data for all drug addicts treated at the Kraków Department of Clinical Toxicology in years 1997, 1998, 1999 and 2000 because of drug overdosing and resultant acute intoxication, because of withdrawal syndrome and also the opiate dependent patients qualified to methadone maintenance programme. The patients dependent on ethanol were excluded. A progressive increase in number of poisonings with psychoactive substances was noted in analysed years, respectively 231, 298, 331 and 442 patients. Drugs of abuse, were the most frequent cause of admission. Also incidence rate of poisoning expressed per 10,000 of Kraków inhabitants was highest for the cases admitted because of overdosing or craving for narcotics. Opiate derivatives produced at home from poppy straw or from juice of poppy head (so called "kompot" or "Polish heroin") were the most common cause of admission in all the analysed years: increase in number of acutely poisoned, and also increase in number of opiate dependent patients who suffered withdrawal syndrome and sought detoxification was noted in 2000 as compared to years 1998 and 1999. Opiate derivatives followed by amphetamine, as the single toxic agent or in mixed combinations, were still the most common drugs of abuse detected in body fluids. The men were dominant in all the analysed years, but the increase in number of depended women was observed through the years under analysis.

An evaluation of breathing nervous regulation of opiate dependent patients during in 6 months' methadone maintenance treatment programme.

During the methadone maintenance treatment an individually specified doses of methadone should prevent a withdrawal syndrome and may stabilise the activity of respiratory centres of opiate dependent patients. The aim of the study was to evaluate the direction of changes in respiratory pattern parameters of 34 opiate dependent patients (14 women and 20 men) during 6 months' methadone maintenance treatment at the Kraków Department of Clinical Toxicology. Respiratory pattern parameters and occlusion pressure were measured by means of a computer spirometer using "on line" during unrestrained breathing with atmospheric air. Examination of respiratory pattern were performed three times: I--initial examination--before administration of methadone maintenance treatment; II--control examination after 3 months' methadone maintenance treatment; III--control examination after 6 months' methadone maintenance treatment. An increase in values of occlusion pressure and minute ventilation were observed. The times of expiration and total times of inspiration-expiration cycle were shorter in III examination than in the examination before methadone administration. The values for the breathing cycle neuromuscular drive (VT/Tin) were relatively stable, but they were higher than those obtained in the control group. It may be related to the anxiety states and mood alteration. The largest individual variation in consecutive examination were observed for Tin/Ttot index being the timing component of respiratory patterns characteristic for parasympathetic control of breathing.

The changes in spirometric measurements during 6 months' methadone maintenance treatment in opiate dependent patients.

The aim of the study was to evaluate the respiratory system response to individually specified doses of methadone in opiate dependent patients during 6 months' methadone maintenance treatment at the Department of Clinical Toxicology CM UJ. There were 34 persons (14 women aged from 21 to 33 years and 20 men aged 21-46 years) under examination. Examinations were performed three times: I--initial examination--before administration of methadone maintenance treatment; II--control examination after 3 months--methadone maintenance treatment; III--control examination after 6 months--methadone maintenance treatment. Ventilation efficiency was assessed on the basis of the results from a "flow-volume" loop, spirometry and the measurements of the respiratory tract resistance (Rrs) in a computerised system. Rrs was determined by means of the flow-interruption method. The parameters obtained from a "flow-volume" loop and spirometry were stabile within opiate substitution with methadone, whilst the values of respiratory resistance were significantly different. Significant increase in respiratory resistance values between initial and control examination (after 3 months) was noted. The normalisation of respiratory resistance was proved after 6 months treatment. It can indicate the impact of nervous component on spastic reaction of central bronchi.

[Psychoactive agents: an analysis based on cases from the Department of Clinical Toxicology College of Medicine of the Jagiellonian University in Kraków in the years 1997-1999]. / Substancje uzalezniajace w materiale Kliniki Toksykologii Collegium Medicum Uniwersytetu Jagiellonskiego w Krakowie w latach 1997-1999.

The aim of the study was to evaluate the frequency of acute poisoning with psychoactive substances in adult abusers of Kraków population in 1997, 1998 and 1999 and to compare the number of poisoned patients suffering withdrawal syndrome as predominant. 27.2% (n = 945) of all 3472 acute poisonings treated in the Department of Clinical Toxicology in 1997, 36.9% (n = 1193) of all 3236 treated in 1998 and 47.9% (n = 1546) of all 3233 treated cases that were acute poisoning with psychoactive substances among the abusers of Kraków adult population. Ethanol followed by narcotics in 1998, and by drugs coingested with ethanol and by narcotics in 1997 and 1999 was predominant psychoactive agent in all the analysed years. Organic solvents and glue sniffing and drug dependency increased again in 1999. Opiate derivatives produced at home from poppy straw or juice of poppy head were still the most common narcotic detected in body fluids, but decrease in number of acute opiates poisoning was noted in 1999 as compared to previous analysed years. The most of ethanol abusers aged from 30-49 years. The highest incidence of narcotic and drug dependency was noted in age between 20-29 years.

Nervous regulation of breathing in opiate dependent patient. Part I. Respiratory system efficiency and breathing regulation in the first stage of controlled abstinence.

Neurotoxic properties of opioid drugs which are the central nervous system depressant may have also depressive action on the brain stem complex responsible for the breathing control. Disorders of breathing regulation are reflected in respiratory efficiency. The aim of this study was to evaluate the regulation of breathing by measuring of respiratory pattern parameters, occlusion pressure and also to estimate the respiratory efficiency in opiate abusers. There were 76 persons under examination: group I--36 opiates abusers (29 men and 7 women; mean age 22.6 years) treated in the Detoxification Unit of the Department of Clinical Toxicology; group II (control group)--40 healthy persons (25 men and 15 women; mean age 28 years) not dependent of opiates and never treated at the Department. During hospitalisation the functional state of respiratory system was monitored. Ventilation efficiency was determined on the basic of the results from a "flow-volume" curve, spirometry and the measurements of the respiratory tract resistance in a computerised system Lungtest-MES company (Poland). Respiratory regulation was evaluated by means of synchronic measurements of the respiratory pattern (according to the assumption of Milic-Emili) and occlusion pressure P 0.1 (according to Whitlaw assumptions). In the examination performed directly after admission to the Unit the normal respiratory efficiency was noted in 24 persons. 12 persons (33.3%) suffered from the bronchi obturation. In the examination performed after hospitalisation and 9 days of total abstinence the normal ventilatory efficiency was found in 23 persons. In 13 of the patients (38.5%) respiratory obturation was still observed. After treatment in group of opiate abusers compared to control group values of respiratory resistance, occlusion pressure, minute ventilation and VT/T(in) index describing the activity of the central breathing regulation were increased, while the time of expiration and time of total breathing cycle were shorter.

Nervous regulation of breathing in opiate dependent patient. Part II. Respiratory system efficiency and breathing regulation of persons classified to the methadone maintenance treatment.

The measurements of respiratory pattern parameters, occlusion pressure and respiratory tract resistance had never been performed in opiate dependent persons administered by the methadone maintenance treatment. The aim of this study was assessment of ventilatory efficiency and nervous regulation of 35 depended on opiates before starting the treatment. The presently examined opiate addicts classified to the methadone programme had intensified changes in nervous breathing regulation compared to the group of opiate dependent patients treated at the Department of Clinical Toxicology CMUJ in the first stage of controlled abstinence and to the control group. They had the higher values of minute ventilation, occlusion pressure and higher value of tidal volume to the inspiratory flow (VT/TIN) index which is the driving component of the breathing cycle and reflects the activity of the respiratory centres in the spinal cord and pons. A monitoring of respiratory patterns parameters, occlusion pressure and respiratory resistance, which are not disturbed or biased by lack of patient's cooperation, will allow to determinate the direction of changes in ventilatory efficiency in the course of methadone maintenance treatment programme.

Frequency and clinical course of acute carbon monoxide poisoning in relation to the kind of emission gas.

The conversion of domestic supply from illuminating to natural gas in 1975 in Kraków was expected to diminish, or even eliminate the threat of CO intoxication. The aim of the study was to compare the frequency and clinical course of CO poisonings (early or delayed medical complication or death) regarding the source of CO (illuminating or natural gas). Under analysis there were adult inhabitants of Kraków treated at the Department of Clinical Toxicology from 1972 to 1974 when the main source of CO was illuminating gas and those treated from 1994 to 1996 i.e. after the conversion of domestic gas supply from illuminating to natural gas. All the cases of people who died at the scene of the accident prior to any treatment were also included. The frequency of acute poisonings among the inhabitants of Kraków was expressed by the incidence rate per 10,000 inhabitants with regard to age and sex. The severity of CO poisoning was estimated considering age, duration of exposure, carboxyhemoglobin (COHb) level, and the neurological state of patients on admission to the Clinic. Significantly higher frequency of suicidal poisonings was noted in the group of patients poisoned with illuminating gas compared to those poisoned with CO produced by incomplete combustion of natural gas (p < 0.001). No significant differences were noted considering the age of patients hospitalised in both periods. Duration of exposure was significantly longer and carboxyhemoglobin level was significantly higher in the group of patients poisoned with illuminating compared to natural gas. Significantly higher frequency of severe poisonings was noted in the group of patients intoxicated with illuminating gas compared to those intoxicated with natural gas. The frequency of acute CO poisonings in the population of Kraków determined by the incidence rate per 10,000 inhabitants was approximated to 2.4 in all the years analysed. The conversion of domestic supply from illuminating to natural gas significantly decreased the mortality rate. No differences in the number of patients suffering from medical complications were found between the two study periods. A higher incidence of late sequalae (psychoorganic and depressive syndromes) was found in the group of patients poisoned with CO produced by incomplete combustion of natural gas compared to illuminating gas.

The comparison of respiratory resistance and occlusion pressure in alcohol dependent patients who complain or not of the respiratory system disorders.

Alcohol abusers often complain of respiratory symptoms. The aim of the study was to analyse the respiratory pattern parameters and occlusion pressure in chronic alcoholics who complained of respiratory symptoms vs. those who did not suffer from any symptoms before the admission. Also dynamics in changes of spirometry parameters and respiratory pattern parameters during controlled, absolute abstinence while hospitalisation in the Detoxification Unit of the Department of Clinical Toxicology was evaluated. There were 124 study patients: 84 ethanol dependent patients and 40 healthy subject not dependent on ethanol (control group). Ethanol dependency was diagnosed using ICD-10 criteria. The questionnaire according to Fletcher was gathered for each of the subject. The positive results of Fletcher questionnaire (chronic cough + chronic expectoration) was obtained in 43 of the ethanol abusers-group I. The rest of abusers who did not complain of any respiratory symptoms was included to the group II. Respiratory tract resistance was significant the differential factor between the patients with positive results of Fletcher questionnaire and patients who did not suffer any symptoms before admission. Significant differences in occlusion pressure values, were noted between the group of abusers with and without the respiratory symptoms both in the first and control examination.

[The usefulness of Aspargin for supplementing potassium and magnesium in ethanol dependent patients]. / Przydatnosc Asparginu do suplementacji potasu i magnezu u pacjentów uzaleznionych od alkoholu.

Intoxication with many xenobiotics cause serious electrolyte abnormalities which require intravenous supplementation. In chronic and acute but not very severe intoxication an oral supplementation of ions can be sufficient. The aim of the study was to evaluate the usefulness of Aspargin for supplementation of potassium and magnesium in chronic alcoholics suffering from withdrawal syndrome. There were 46 study patients, dependent on ethanol treated at the Detoxification Unit of the Department of Clinical Toxicology in Krak w. A differently intensified symptoms of ethanol withdrawal syndrome were noted according to CIWA-A scale in all the patients. Concentration of potassium and magnesium was monitored through the hospitalisation. Except a basic treatment (fluid supplementation, benzodiazepines) also Aspargin (three times a 2 tablets per day) was administered to each of patient for 7 to 10 days. No respiratory, muscular and gastrointestinal symptoms due to hypopotassemia and hypomagnesemia have been noted while hospitalisation in any patient so it could be suspected, that oral supplementation with Aspargin was sufficient to keep these ions balanced. Administration of Aspargin was beneficial to patient and the treatment outcome.

[Evaluation of carbon monoxide cardiotoxicity in group poisonings]. / Ocena kardiotoksycznego dzialania tlenku wegla w zatruciach zbiorowych.

The aim of the study was to estimate the usefulness of rest 99mTc-MIBI SPECT scintigraphy to evaluate carbon monoxide cardiotoxicity in acute group poisonings. There were 7 study patients (5 men and 2 women) aged from 14 to 35 years treated at the Department of Clinical Toxicology intoxicated with CO at three different sites: three persons were intoxicated at one, two persons at the second and the next two persons at another site of exposure. As derived from interview the circumstances, source and duration of exposure were similar within the separate group. This enables a comparison of clinical course of carbon monoxide poisoning, particularly the circulatory system of people who were simultaneously exposed to the same source of carbon monoxide. Measurement of COHb, blood lactate level, duration of exposure and ECG examination were performed on admission to the Clinic. The enzymes activity (ALT, AST, CPK) were evaluated after 24 hours. The rest 99mTc-MIBI SPECT scintigraphy was performed in all patients two to five days after intoxication. The changes in myocardial scans were graded according to the arbitrarily accepted point scale. Considering the results of ECG and enzymes activity only, no objective were found to diagnose the cardiac dysfunction. However the perfusion scintigraphy scans indicated regions of myocardium that have decreased blood flow in all the study patients.

[Analysis of observations in the admissions room of the Krakow Clinical Toxicology Department of substance dependent persons in relation to changes in central nervous system metabolism caused by substances of abuse]. / Analiza obserwacji w izbie Przyjec Kliniki Toksykologii CM UJ w Krakowie osób uzaleznionych, w swietie danych o zmianach w metabolizmie osrodkowego ukladu nerwowego wywolanych przez substancje uzalezniajace.

Authors presented the course of clinical observation of 393 acutely intoxicated patients dependent on psychoactive substances (28%) or ethanol (72%) who were discharged from the hospital at their own request before diagnosis and treatment were completed. In the first stage of detoxification the different intensity symptoms of toxic coma (25% of patients), behavioral changes-agitation and aggression (16%) and also the disturbances in consciousness accompanied by tremor and vegetative storm (15%) were observed. Authors pointed out that among others the neurobiological changes in brain reward systems of patients who discontinued diagnosis and treatment could be endangering for both the patient and the doctor. They postulate that criteria of life threatening state should by more accurately defined and the methods of full security for patient and doctors should be worked out.

[Essential, economic and social significance of the Poison Information Center for public health]. / Znaczenie merytoryczne, ekonomiczne i spoleczne Osrodka Informacji Toksykologicznej w ochronie zdrowia.

The role of toxicological information consisting of chemical substance toxicity, clinical signs and symptoms, treatment and diagnosis of poisonings is presented in the study. These data are collected in computer programmes TOKSY 5, TOKSY7 (MacroSoft Warazawa) which together with American CCIS data base (MICROMEDEX, Denver, Colorado) and IPCS INTOX Database are helpful instrument while giving the toxicological information or/and medical consulting. All cases are registered in IPCS (International Programme on Chemical Safety) INTOX SYSTEM data base that enables epidemiological analysis and also an evaluation of economical and social effects caused by poisonings.

Acute pesticides poisoning in the Kraków Department of Clinical Toxicology in 1986-1995.

The aim of the study was to evaluate the number and the course of acute pesticides poisoning treated in the Department of Clinical Toxicology in 1986-1995. During that period 264 cases (189 men and 75 women) of acute pesticides poisoning were treated. Suicidal oral ingestion followed by inhalation and dermal exposure was the most common cause of acute intoxication. Organophosphates and carbamates were the most common cause of acute intoxication. Poisonings with dipyridyls and sulfonylurea derivatives are relatively rare. The highest number of poisonings was noted in age group 30-39 years. In 37% of the total analysed cases the co-ingestion of ethanol was noted. As organophosphorous compounds were the most common cause of acute pesticides poisoning, the gastric lavage + intensive care treatment + specific and non-specific antidotes were the most common therapeutic management. Duration of hospitalisation was dependent on the kind of pesticide. The longest hospitalisation required the patients poisoned with organophosphates. A full recovery was noted in 57.6% of poisoned patients. 34.1% of patients suffered different organ injury mostly from respiratory and central nervous system. 22 (8.3%) the fatal cases were noted in analysed period.

Multiorgan damage in acute oral carbamates poisonings.

The aim of the study was to evaluate the frequency and the kind of multiorgan damage in acute oral carbamates poisonings. Under analysis there were 36 carbamates orally poisoned patients treated at the Department of Clinical Toxicology in the years 1987-1997. Patients with the liver or biliary tract diseases, chronic circulatory insufficiency symptoms, HBs antigen carriers, who suffered head traumas, CNS illness and heavy drinkers were excluded from the study. The organs damage was noted in 91.7% of the poisoned patients. The respiratory system followed by the CNS and the liver were mostly affected by carbamates toxicity. The frequency of pathological changes in the kidney and circulatory system was relatively lower. Only in a few persons peripheral nervous system injuries were noted. In 15% of the examined group the injuries of one organ only was stated. In 48.5% of the patients simultaneous injury of two and three organs or systems were noted. 36.3% of the patients suffered from multiorgan (four or more) damage. In all the severely poisoned patients (III degree) the organs damage was noted. In 53% of them the simultaneous damage of four or more organs/systems was noted. In the group of patients stated as moderately poisoned on admission to the clinic, the multiorgan damage (2-3 organs/systems) was found in 77% of the patients. The lowest number of organ damage was observed in the group of slightly poisoned patients.

Acute ethanol poisonings during the New Year's Eve party "95/'96 in Kraków.

Distilled spirits are the major source of ethanol consumption in Poland. Such concentrated alcohol is drunk quickly, especially in teenager groups who consider consumption of 250 or 500 ml of vodka during one hour or one hour and half as quite normal. For two years the New Years Eve party has been celebrated in the Main Market Square in Kraków. In 1995 unfavourable weather conditions had been observed for at least 14 days before the New Year's Eve night. During that night only 15 people-participants of the party were admitted to the Department of Toxicology. The aim of this study is to present the cases of poisoned people with ethanol during the last night of the year 1995. All the patients were young (10 poisoned patients were below 17 years of age), considerably low body temperature, and relatively low coma grade. 80% of the patients were admitted between 0:00 and 5:00 a.m. after 200 minutes since the moment they started to drink alcohol. Blood ethanol concentration ranged from 1.2 to 4.23 g/L and serum osmolality from 338 to 440 mOsm/kg H2O. Both ethanol concentration and serum osmolality progressively rose reaching the highest values in the group of patient with III coma degree (p < 0.001). All the cases of acute ethanol poisoning presented in the study had a good outcome, as patient were admitted at the Clinic in relatively short time after symptoms of poisoning have occurred.

Fetal hemoglobin as a possible marker of susceptibility to working conditions for certain men exposed to industrial pollutants.

In 43 from 222 men (19.4%) employed in a coking plant a higher than normal concentration of fetal hemoglobin (HbF) was found, whereas an elevated level of HbF was detected in only two from 87 persons (2.3%) working in the cold rolling mill of the steel mill 'Huta Sendzimira', Krakow, Poland. Subjects employed in the coking mill worked in a much more polluted atmosphere than those in the cold rolling mill. It is speculated that synthesis of HbF may be a marker of the effect of unfavorable working conditions on some susceptible persons.

Acute poisonings with drugs of abuse.

The drug overdose resulting in acute intoxication diagnosed in the 106 drug abusers in period form June to December 1994. The screening drugs identification was performed using immunoassays Triage and Vitalab Eclair manufactured by MERCK. Benzodiazepines followed by barbiturates and opiods were most often the cause of acute poisonings among the adult Kraków inhabitants. The results presented indicate that only adequate clinical observation, laboratory tests performance and establishing of intoxication state (acute poisoning, chronic intoxication or withdrawal) allows a complete patient evaluation.

Humoral immunosuppression in men exposed to polycyclic aromatic hydrocarbons and related carcinogens in polluted environments.

We evaluated humoral immunity by measuring IgG, IgA, IgM, and IgE concentrations in 274 male workers in an iron foundry in Cracow, Poland. There were two groups: 199 coke oven workers and 76 cold-rolling mill workers. The groups were similar with respect to age, length of work (average 15 years), and smoking habits. Exposure to polycyclic aromatic hydrocarbons (PAHs), assessed by personal and area monitoring, ranged from 0.2 to 50 micrograms/m3 benzo[a]pyrene in coke plant workers and was of 3-5 magnitudes higher than in the cold-rolling mill employees. Comparison of the two groups revealed a marked depression of mean serum IgG and IgA in coke oven workers (p < 0.001, Student's unpaired t-test). In the same subjects, serum IgM had a tendency to decrease, whereas serum IgE showed a trend toward higher values. Thus, workers exposed chronically to complex mixtures of air pollutants, composed primarily of PAHs, develop immunosuppression. It remains to be established whether the immunosuppression described here is related to the frequent development of lung cancer reported in coke plant employees. Workers exposed chronically to PAHs should have serum immunoglobulins monitored regularly.

Comparison of results derived from follow-up examination of respiratory systems in chosen groups of metallurgists.

In a 16.5-year follow-up study of the steel industry we investigated the relation of chronic occupational exposure to the changes of ventilatory efficiency and to the frequency of chronic bronchitis (Chronic Obstructive Pulmonary Disease--COPD) in a group of 65 men working in the harmful environment of a Coking Plant (CP). The reference group comprised 34 employees of Cold Rolling Mill (CRM) working in favorable hygienic conditions. The faster decline of VC and FEV1 were noted in the group of CP in comparison to the control group. Also the frequency of pathologic values of RT was significantly higher (p < or = 0.001) in the exposed group. The incidence of COPD increased more in the group of CP than in the group of rollers. No differences in the annual decline of FEV1 and VC between smokers and nonsmokers from CP were noted, while in the group of men working in favorable environmental conditions the differences between smoking categories were significant. It suggests that the impact of occupational exposure is so powerful that it can mask the unfavorable influence of cigarette smoking on the ventilatory function of men working in a Coking Plant.

[Analysis of respiratory parameters before and after working in manual laborers at a tobacco factory]. / Analiza wartosci wskazników wentylacyjnych przed praca oraz po jej zakonczeniu u pracowników fizycznych przemyslu tytoniowego.

From the group of 102 workers of local cigarette factory 51 persons had a contact with tobacco leaves before fermentation and other 51 workers with after process of fermentation. Values of spirometric parameters before and after 8 hour lung occupational exposition to tobacco leaves were evaluated in both groups. Increase of obturation of both large and small airways was found after workshift. 31 of examined persons had more than 20% inferior values of FEV1, Raw and FEF 25/75. That hyperspasmatic reaction of bronchi was found both in subjects with signs of obturation and in persons with normal results in examination before workshift. This finding concerned mostly workers who inhaled dust of tobacco leaves prior to fermentation.