[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[Side effects after the usage of Chinese dieting product Meizitanc]. / Dzialania niepozadane spowodowane stosowaniem chinskiego srodka odchudzajacego Meizitanc.

UNLABELLED: Side effects of self-treatment of eight obese women aged between 28 and 45 (average 36.5) with the body mass index (BMI) between 28 and 32 (average 30) kg/m2 have been described. All these women, without any medical consultation and upon their own will had been using Meizitanc as the only remedy for slimming. They started with a dosage of 1 capsule per day, gradually increasing the Meizitanc dose to 3 capsules a day. The patients had used the drug from 2.5 to 6 (average 3.2) months. There were many side effects observed in all women like palpitation, headache and vertigo, warm feeling, nervousness, and tremor of the hands which was observed in four patients. All these effects appeared during the last few weeks and thus forced them to get the consultation in the Poison Information Centre in the Medical University of Gdansk. All capsules were examined with the use of gas chromatography and mass spectrophotometer GC/MS. It was found that each capsule contained 10 mg of sibutramine. There was no information about the presence of sibutramine in the composition of Meizitanc on the package and leaflet. After discontinuation of Meizitanc all side effects disappeared. CONCLUSIONS: Special caution is advised during the Meizitanc treatment. In case of any side effects like palpitation, headache and vertigo, nervousness or tremor which take place during the Meizitanc treatment the medical consultation is needed.

Suicidal attempt of a schoolgirl to demonstrate against the school teacher and try to make her quit the school.

UNLABELLED: A case of a 16-year-old schoolgirl who had admitted a demonstrative suicide attempt against her school teacher thus trying to make the teacher leave the school has been presented. During the observation period in the Emergency Department the nurse taking care of the patient overheard that during her talks with the friends, the girl had been continuously urging them to swallow the same set of tablets, call the ambulance and get admitted to the hospital. The anamnesis revealed that three schoolmates decided to get rid of one of the teacher from their school by accusing her of mental cruelty which had led them to suicidal attempts. It was done mainly because of the bad marks they had got from the teacher. The idea was undertaken by our patient due to many news transmitted in the newspapers and television during last months in which the teachers were blamed for a lot of incidents which had taken place in different schools in Poland. Despite the fact that in many of these events the teachers were both physically and mentally tormented by the pupils the opinions presented by mass-medias were always against them. Our patient said that in such circumstances it was supposed to be an easy way to solve all the problems with unlike teacher. CONCLUSIONS: The physicians should pay more attention on suicidal attempts causes specially in adolescents. Adolescents possess poor knowledge of the lethal potential of drugs, specially over-the-counter medications. The media have to take more responsibility for transmitting news concerning youth which should be more honest and verified.

[Perspectives of inhaled insulin treatment]. / Perspektywy leczenia insulina wziewna.

In the article some merits and some limitations of inhaled insulin (Exubera produced by Pfizer) in the treatment of adult patients with type 1 or 2 diabetes were presented. Up till now about 3500 volunteers usually in short-term study periods (6 months) were examined. Some patients were observed in the course of treatment even 4-7 years. Inhaled insulin was well tolerated by patients and they accepted with satisfaction this new form of drug. Main adverse events were a small decrease in the forced expiratory volume at 1 s (FEV1) and a small decline in carbon monoxide diffusion capacity with no clinical significance a well as a mild or moderate cough occurring temporally. Inhaled insulin is contraindicated in smokers and patients with bronchial asthma, bronchitis and pulmonary emphysema. Despite the approval of inhaled insulin for use in adult patients with type 1 or 2 diabetes in the United States and European Union in January 2006, Pfizer designed Real World Trial to estimate the costleffectiveness of this drug and the effect of the availability of Exubera as a treatment options for glycemic control.

[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.

[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.

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.

[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.

Heat stroke complicated by liver failure and hyperbilirubinaemia--a case report.

Heat stroke may appear as a result of exposure to high environmental temperature or strenuous exercise. It represents a medical emergency characterized by an elevated core body temperature and multi-organ failure. We have described a case of a 41 year-old female after sun exposure, who was admitted to the hospital with the temperature of 42 degrees C. Because of high plasma bilirubin level the Molecular Adsorbent Recirculating System (MARS) was started. Three sessions of MARS, which lasted for eight hours each, were conducted on 15h, 18th, and 23rd day of hospitalization. The procedure was well tolerated by the patient and resulted in a sustained decline of plasma bilirubin from 33.5 to 14.7 mg/dl. The female was discharged from the hospital in good general condition. The two months follow up showed that the patient felt very well, and the plasma bilirubin was reduced to 2.2 mg/dl.