[Rhabdomyolysis as an unspecyfic symptom of mushroom poisoning--a case report]. / Rabdomioliza jako niespecyficzny objaw zatrucia grzybami--opis przypadku.

Since 2001 a number of cases of mushroom poisoning with concomitant rhabdomyolysis have been described. Among the edible mushrooms growing in Europe, these reports concerned only Tricholoma equestre. The results of animal studies suggest that rhabdomyolysis could be a consequence of consumption of other edible fungi, and its occurrence depends on the amount of ingested mushrooms and individual sensitivity. To the best of our knowledge, this is the first report of rhabdomyolysis associated with the consumption of edible mushrooms from Leccinum and Boletus species. A 57-years old man was admitted to the hospital due to severe pain and weakness of thigh muscles with a high serum creatine kinase activity -3811 U/L. Within two days before hospitalization he consumed repeatedly large quantities of stewed Leccinum and Boletus mushrooms. Clinical signs of toxicity and biochemical changes subsided after several days of hospitalization. Rhabdomyolysis after ingestion of a large amount of mushrooms can be an unspecific symptom, unrelated to fungi species.

[Analysis of exposure to pepper spray as a part of preparing hospital to help victims of mass chemical incidents]. / Analiza narazenia na gaz pieprzowy jako element przygotowania szpitala do pomocy ofiarom masowych skazen chemicznych.

We analyzed an incident of exposure to pepper spray 35 persons, including 29 children. Medical procedures were difficult because of the lack of reliable information about the nature of exposure, lack of hospital action plan for chemical accidents and established principles of cooperation with poison control center, as well as the need of extensive medical documentation for each patient.

[Factors determining students' knowledge on wild mushrooms]. / Czynniki warunkujace wiedze studentów o grzybach dziko rosnacych.

A survey was conducted among students of university schools in Nowy Sacz, Biala Podlaska and Zamosc to determine the guidelines of mushroom poisoning prevention. The study included 580 people. The dependence of knowledge about mushrooms from the place of origin of students, frequency of participation in mushrooming, preferred sources of information about mushrooms, major of study and self-competence in discsriminating of mushrooms was determined. Mushrooms gathered nearly 80% of respondents. Residents of large cities more often that those living in villages and small towns have difficulites in distinguishing the edible and poisonous mushrooms. People often participating in mushrooming retain proper habits during the harvesting and processing of mushrooms. Irrational ways of distinguishing edible mushrooms from poisonous are often rejected by inexperienced people than by frequently gathering mushrooms. Nearly 20% of respondents, regardless of their own experience and self-assessment of their competence in discriminating mushrooms belive that after culinary preparation can by safely consume even deadly poisonous species. The primary source of knowledge on mushrooms for the majority of responents are parents. There was no correlation between the preferred source of information about mushrooms and belief in the myths about them. Knowledge on the mushrooms of medical students (nursing, emergency medical service) is not greater than students other courses.

[Knowledge of students of tourism and recreation Academy of Physical Education on wild mushrooms]. / Wiedza studentów turystyki i rekreacji Akademii Wychowania Fizycznego na temat grzybów dziko rosnacych.

Prophylaxis of acute poisoning with mushrooms is justified because of the relatively high risk of death associated with these intoxications. Mushrooming in Poland has a long tradition and knowledge about mushrooms is usually passed on in families. In recent years the mushrooming becomes an organized form of recreation. Graduates of tourism and recreation should have a minimum of reliable knowledge about mushrooms, to ensure the safety of persons entrusted to their care. The knowledge of wild mushrooms among students of tourism and recreation was tested by means of questionnaire. Mushrooms gathered 108 out of 125 respondents. The primary source of knowledge about mushrooms for 84% of the mushrooms pickers were the parents. Up to 70% of respondents considered at least one of irrational methods useful to distinguish edible mushrooms from the poisonous. Thirteen percent of those polled believed that by simple means mushrooms may be deprived of their toxic properties. Knowledge of the only one deadly poisonous mushrooms growing in Poland was 53%. The tourism and recreation students must pass basic knowledge about mushrooms and identify reliable sources of knowledge in this field.

[Acute gamma-butyrolactone poisoning with withdrawal syndrome]. / Ostre zatrucie gamma-butyrolaktonem z zespolem abstynencyjnym.

Gamma-butyrolactone (GBL) is a solvent that are part of many consumer products and in most countries can be legally purchased in the form of almost pure substance. After ingestion GBL is rapidly converted to gamma-hydroxybutyric acid (GHB). In recent years, GBL became a legal alternative to GHB, which is used widely since 1990s as a club drug and date rape drug. It is believed that abuse of GBL is not frequent in Europe, except for certain specific groups, mainly in urban centers in the west of the continent. We present a case of acute GBL poisoning with the withdrawal syndrome in 23-year-old man living in a rural area in eastern Poland. The patient was admitted to the Intensive Care Unit (ICU) because of coma of unknown origin. On admission erosions of the lips and mouth was seen. Ethyl alcohol was not present in blood sample, urine screening tests for drugs were negative. During his stay in the ICU patient required ventilatory support, was periodically agitated with muscular jerks and opisthotonos. The later medical history revealed that the patient from two years used GBL, which purchased as wheels cleaner. The tolerance developed, and the interruption of use of substance triggered symptoms of withdrawal. GBL abuse occurs in different social groups and is at risk for acute toxicity and the development of physical dependence.

[Acute transient left-ventricular systolic disfunction during alcohol withdrawal]. / Ostra przemijajaca dysfunkcja skurczowa lewej komory w przebiegu alkoholowego zespolu abstynencyjnego.

Stress cardiomyopathy is an acute transient left ventricular dysfunction, associated with emotional stress. In the course of alcohol withdrawal abnormalities of perfusion and myocardial contractility have been described, manifested in the scintigraphic study, with the absence of changes in ECG and echocardiography and probably caused by sympathicotony, in analogy to severe emotional stress. We present a case of acute left ventricular dysfunction during alcohol withdrawal with significant changes in echocardiography and ECG mimicking acute coronary syndrome. In a 53-year-old woman, treated in the internal ward because of abdominal pain, vomiting, and moderately elevated pancreatic amylase in serum and urine, chest pain and shortness of breath at rest occurred during the first day of hospitalization. These symptoms were accompanied by ST segment elevation in V2-V3, negative T waves in V2-V6 and an increase in troponin. Coronarography excluded significant changes in the arteries, the echocardiography revealed apical akinesis with left ventricular ejection fraction (LVEF) 30%. By hospital day 3 disorientation and behavior disorders corresponding of alcohol withdrawal appeared. In subsequent days improvement in LV systolic function was observed with LVEF increase to 53%. ECG changes in the form of a deep negative T waves in I, II, aVL and V2-V6 persisted to the end of hospitalization.

[Acute inhalation imidacloprid poisoning--a case report]. / Ostre wziewne zatrucie imidachloprydem--opis przypadku.

According to the best of my knowledge this is the first report of acute intoxication with imidacloprid in Poland. The 48-years old women was admitted to the hospital because of the symptoms of gastroenteritis, which occurred after inhaled exposure to imidacloprid. Mild increase in leukocyte count was found in laboratory examination. The symptoms disappeared after 2 days of the treatment. For imidacloprid, regarded as safe for humans being, toxicity can occur through inhalation exposure.

Acute intoxication with Tricholoma equestre--clinical course.

UNLABELLED: We observed all patients admitted to the poison centers for children and adults in Gdansk and Biala Podlaska, between the years 2001 and 2010, who were intoxicated with Tricholoma equestre. The main clinical symptoms, included muscle weakness, nausea without vomiting, diaphoresis without fever, and in the most serious cases acute respiratory failure. In biochemical results there were seen marked increase in CK, AST and ALT levels. The mortality rate was 20%. It seems that the severity of intoxication are correlated with the amount of ingested mushroom. CONCLUSIONS: Physicians should be aware of the possibility of acute intoxications after repeated consumption of large quantities of Tricholoma equestre. The clinical picture of poisonings with this wild mushroom might be different in children and adults and depends on ingested amount of these mushrooms. The most serious adverse effect include acute respiratory failure and myocarditis with cardiac arrhythmia and cardiovascular collapse. Intoxication of Tricholoma equestre may be connected with the high mortality rate about 20%.

[Drug-induced agranulocytosis--case reports and literature review]. / Agranulocytozy polekowe--opis przypadków i przeglad pismiennictwa.

Drug-induced agranulocytosis is believed to be an extremely rare adverse drug reaction. It can be caused by various drugs, but it is mostly described in patients taking antithyroid drugs, antipsychotics and antibiotics. Four cases of patients treated for drug-induced agranulocytosis from January 2006 to March 2007 were described. In two cases agranulocytosis appeared in the course of therapy with methimazole. In one patient agranulocytosis was caused by perazine and by promazine or olanzapine in the last one. In all of the cases the leading symptom was fever, three of our patients had changes of mouth mucosa. All patients were treated with betalactam antibiotics. Granulocyte colony-stimulating factor (G-CSF) was not used in anyone. The recovery of white blood cell count and granulocyte count in all of the patients was detected in the first ten days of hospitalization.

[The knowledge about gamma-hydroxybutyric acid as by students of Physical Education Academy]. / Wiedza studentów Akademii Wychowania Fizycznego na temat kwasu gamma- hydroksymaslowego (GHB).

Gamma-hydroxybutyric acid is a substance stealthily used by criminals to facilitate sexual assaults. It is also known as doping agent in sports. Physical Education Academies should prepare their graduates to be educators for young people, their trainers, organizers of sports and recreational events. Second year students of two majors: physical education and tourism and recreation were surveyed by means of questionnaire on "date-rape drug". As much as 320 among 327 students surveyed had heard about "date-rape drug". However their knowledge on it was shallow and unsystematic. None of the surveyed knew that the substance of "date-rape drug" could also be used as a doping agent. Only 31% of respondents were aware of existence of the test to detect "date-rape drug" in drinks. Physical Education Academy students should be thoroughly and relevantly educated on the matter of pharmacologic doping agents and drugs endangerment.

Acute poisoning with Tricholoma equestre.

Four cases, including three adults and one child, suffering from acute poisoning with Tricholoma equestre were described. The patients had eaten from 100 to 400 grams of the mushroom within a few consecutive meals. After consuming about 1000 grams of Tricholoma equestre for 3-4 days, the subjects developed fatigue, muscle weakness, myalgia, and in two cases acute respiratory failure with the need of respiratorotherapy. Maximal serum CK was 48136 U/L in the adults and 306 U/L in children. Maximal serum levels of AST and ALT were 802 U/L and 446 U/L in adults and 39 U/L, and 56 U/L in a child. All routine biochemical tests were within normal range. No other causes of rhabdomyolysis such as parasitic or viral infections, immune diseases, trauma or exposure to medications were found. Patient, aged 72 yrs., who developed acute respiratory failure, died in the second day of hospitalization. In other patients all the above mentioned symptoms and biochemical abnormalities disappeared from 2 to 3 weeks of hospitalization. Physicians should be aware of the possibility of appearance of rhabdo-myolysis after repeated consumption of large quantities of Tricholoma equestre.

[Diagnostic difficulties in foodborne botulism--case reports and literature review]. / Trudnosci diagnostyczne w zatruciu jadem kielbasianym--opis przypadków i przeglad pismiennictwa.

Food borne botulism is a relatively rare clinical syndrome, which symptomatology is generally highly distinctive. The physicians of various specialties should be familiar with the symptoms of botulism because its sings concern the nervous system, the organ of sight and the gastrointestinal system. In older persons with coexisting chronic diseases some symptoms of botulism may be not distinctive or may mimic exacerbation of early existing diseases. The handbook descriptions present the food borne botulism as dramatic and often deadly disease. However in some cases this disease can have mild course and poor symptomatology. Two cases of food borne botulism with different clinical course are presented in this paper, when the correct diagnosis was established with delay. A 78-year-old man was admitted with the symptoms of pneumonia and dizziness of uncertain aetiology. The diagnosis of food borne botulism was established in 10th day of hospital stay, when the most symptoms were not present. Despite of such late diagnosis and relatively good patient's condition a therapy with antitoxin was administrated. The second case reports a 70-year-old man with chronic heart failure, diabetes and obesity, when the delay of correct diagnosis was about of 24 hours. Despite of relatively early antitoxin administration and intensive supportive care patient died in 11th day of hospital stay.

[Quantitative analysis of heart scintigraphy (99mTc-MIBI GSPECT) with regional myocardial wall motion and thickening assessment for detecting myocardial injury in patients after acute paracetamol poisoning]. / Zastosowanie analizy ilosciowej badania 99mtc- MIBI GSPECT z ocena odcinkowej ruchomosci scian i grubienia skurczowego miesnia lewej komory w aspekcie oceny stopnia ogluszenia miesnia sercowego w ostrym zatruciu paracetamolem.

UNLABELLED: The aim of the study was to evaluate the myocardium function in acute paracetamol poisoning using 19mTc-MIBI GSPECT. MATERIAL AND METHODS: Under examination there were 25 acutely paracetamol poisoned patients (age: 24.5 +/- 6 years) treated at the Ward of Toxicology and Environmental Diseases. The control group necessary to perform quantitative analysis of myocardial scintigraphy consisted of 20 people examined in Nuclear Medicine Unit with normal results of 99mTc-MIBI GSPECT examination. RESULTS: The quantitative analysis of the heart scintigraphy (GSPECT) revealed that, the average value of left ventricle ejection fraction (EF) in examined women and men after paracetamol poisoning was lower than in control group, while end diastolic (EDV) and end systolic volumes (ESV) were higher; these differences were not statistically significant. Indicators of regional wall motion of the left ventricle were lower for the most of the heart segments. According to the control group, they were significantly lower for anterior and inferior LV segments. Wall thickening analysis revealed the impaired systolic thickening of majority of heart segments in examined group of patients; the wall thickening was the lowest for infero-lateral and septal segments in women and for inferior, infero-lateral and anterior segments in men. CONCLUSIONS: The quantitative analysis of myocardial perfusion scintigraphy (99mTc-MIBI GSPECT) with wall motion and wall thickening assessment, showed that the left ventricle function was usually diffusely depressed in paracetamol poisoned patients. The disturbances of regional wall motion of anterior and inferior wall (LV) were mainly visible.

[Chronic ethanol abuse related hospitalisation in the Internal Medicine Department of the Specialist Hospital in Biala Podlaska (Poland)]. / Zaburzenia spowodowane przewleklym naduzywaniem alkoholu jako przyczyna hospitalizacji w Oddziale Chorób Wewnetrznych Wojewódzkiego Szpitala Specjalistycznego w Bialej Podlaskiej.

The admission to a hospital and abrupt cessation of drinking often provokes an alcohol withdrawal syndrome in an alcohol dependent patient. The patients hospitalised in relation to chronic ethanol abuse in years 2001-2002 at the Internal Medicine Ward of the Specialist Hospital in Biala Podlaska were subjected to the study. In those years alcohol related patients made 2 and 3% of the total amount of patients, respectively. Among the patients, men aged 40-49 years old prevailed. The most common diagnoses in the analysed group were: alcoholic liver disease, liver cirrhosis and acute pancreatitis. In the treatment of withdrawal symptoms diazepam was used. Only few percent of patients in the analysed group needed physical restraints because of their great agitation. Early recognition and correct treatment of threatening alcohol withdrawal syndrome diminishes the risk of severe symptoms and complications.

[Gastric lavage, hemodialysis and specific antidotes in acutely poisoned patients treated at the Specialist Hospital in Biala Podlaska (1993, 2001 and 2002)]. / Plukanie zoladka, hemodializa i specyficzne odtrutki u pacjentów leczonych z powodu ostrych zatruc w Wojewódzkim Szpitalu Specjalistycznym w Bialej Podlaskiej w latach 1993, 2001 i 2002.

Gut decontamination, the methods of extracorporeal elimination of poisons and antidote use are the specific measures in clinical toxicology. Statistically they are not often used in intoxicated patients. It is not known, in how many cases of poisoning treated outside toxicological units are they applied. Approximately 110 poisoned patients were hospitalised each year in the Specialist Hospital in Biala Podlaska in years 1993, 2001 and 2002. Gastric lavage was performed in about 50 percent of those cases, especially often in children up till third year of life and in the cases of poisoning with medical drugs. The Gut Decontamination Position Statement of AACT and EAPCCT, published in 1997, had no significant impact on use of decontamination procedures in our hospital. Haemodialyses were performed in 3-5% of poisoned patients. All those patients were poisoned with ethylene glycol or methanol. Only 4 specific antidotes were used in years 1993, 2001 and 2002. The most commonly used antidote was ethanol, despite its level is not measured in our laboratory. Recommendations for gut decontamination should be widely popularised. The use of activated charcoal may be in many cases more suitable as a gastric lavage. Safe and effective use of ethanol as an antidote in a hospital requires its measuring in own laboratory.

[Two cases of rhabdomyolysis with a different clinical course]. / Dwa przypadki rabdomiolizy o róznym przebiegu klinicznvm.

Rhabdomyolysis is a syndrome provoked by the injury to skeletal muscles and the release of muscle cell contents into the plasma. The aetiology and clinical course are extremely variable. This is sometimes the reason of the diagnostic difficulties or even errors. Acute renal failure is the often and serious complication of rhabdomyolysis. The correct and early diagnosis of rhabdomyolysis is a key to successful treatment and prevention of the possible complications. Two cases of rhabdomyolysis with different aetiology and clinical course are presented in this paper. A 39-year-old man was admitted with the symptoms of dyspepsia. During the first day he developed the acute renal failure and later the acute respiratory failure. The initial serum creatine phosphokinase (CPK) activity was about 225,000 U/L. Haemodialysis, plasmapheresis and respiratory therapy were performed. A 25-year-old man was admitted with the swollen leg of the uncertain origin. His initial CPK activity was 18,993 U/L. The patient was treated with the infusions of fluids and sodium bicarbonate. He did not develop renal failure. Despite of the initial diagnostic doubts, in both cases the outcome was excellent.