Quest for breathing: proliferation of alveolar type 1 cells.

There is much evidence that the vertebrate lung originated from a progenitor structure which was present in bony fish. However, critical basic elements for the evolution of breathing in tetrapods, such as the central rhythm generator sensitive to CO2/pH and the pulmonary surfactant, were present in the lungless primitive vertebrate. This suggests that the evolution of air breathing in all vertebrates may have evolved through exaptations. It appears that the capability for proliferation of alveolar type 1 (AT1) cells is the "critical factor" which rendered possible the most radical subsequent innovation-the possibility of air breathing. "Epithelial remodeling," which consists in proliferation of alveolar cells-the structural basis for gas diffusion-observed in the alimentary tract of the gut-breathing fishes (GBF) has great potential for application in biomedical research. Such a process probably led to the gradual evolutionary development of lungs in terrestrial vertebrates. Research on the cellular and molecular mechanisms controlling proliferation of squamous epithelial cells in the GBF should contribute to explaining the regeneration-associated phenomena that occur in mammal lungs, and especially to the understanding of signal pathways which govern the process.

[Brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) blood levels in patients with acute carbon monoxide poisoning - a preliminary observations].

Background: Neurotrophins are the family of proteins which stimulate and regulate the process of neurogenesis. Several factors belong to the family, mainly nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT 3), and neurotrophin-4/5 (NT-4/5). Acute poisoning with carbon monoxide (CO), which usually is accompanied by neurologic symptoms, can potentially change the secretion profile of neurotrophins. Aim of the study. The main goal of the study is to assess the changes of NGF and BDNF plasma levels during an acute phase of CO poisoning as well as immediately after recovery. Additionally, the relationship among neurotrophin levels and selected aspects of clinical course of CO poisoning were studied. Materials and Methods: The study group consisted of 18 patients (mean age: 31.8±10.3 years) hospitalized in Toxicology Department of University Hospital in Cracow because of acute CO poisoning. There were 10 women (mean age: 30.2±6.9 years) and 8 men (mean age 33.9±13.7 years) in the group. The levels of NGF and BDNF were evaluated using immunoenzymatic method (ELISA) in plasma samples taken thrice in each patient. The sample 1. was taken during hospital admission, the sample 2. about 12-36 hours after admission, and the sample 3. just before the hospital discharging (usually, on the 3rd-4th day). The clinical data were collected from patients' anamnesis, physical examination and neuropsychological evaluation. The statistical analysis were performed using tools comprised in STATISTICA 12.0 PL (StatSoft Polska, Cracow, Poland) software. Results: The majority of NGF plasma levels were less than 14 pg/mL (values below the limit of quantification), contrary to the sole case of 34.3 pg/mL. BDNF plasma levels ranged from 4.8 ng/mL to above 48 ng/mL, i.e. they were higher than the upper limit of measurement range for the plasma dilution which had been used. The comparison of NGF and BDNF plasma levels in the study group with their analogues in healthy volunteers taken from the literature indicates that NGF level declines and BDNF level rises in patients with CO poisoning. The profile of BDNF concentrations in the majority of patients formed the characteristic pattern: BDNF sample 1. > BDNF sample 2. < BDNF sample 3. Taking all the values of BDNF higher than 48 ng/mL as equal to 48 ng/ mL, the statistically significant difference among 3 sample series was found according to BDNF levels. Maintaining the above mentioned assumption, the statistically significant negative correlation between the number of higher cognitive functions disturbed in one patient at the same time and the BDNF levels in sample series 2 was discovered, as well as the weak correlations between BDNF level in sample series 1 and carboxyhaemoglobin or lactate level. Moreover, weak but statistically significant correlations were present between the duration of CO exposure and BDNF levels in each sample series. Conclusions: The NGF plasma level is probably declined, while the BDNF plasma level is increased in patients with acute CO poisoning. The concentration­time curve for the plasma BDNF may sometimes undergo fluctuations with two peaks on its course. Plasma BDNF level may serve as a biological marker of disturbed higher cognitive functions in acute CO poisoning. Some clinical aspects of CO poisoning (duration of exposure, HbCO and lactate blood levels) may influence BDNF level.

Proteins as biomarkers of carbon monoxide neurotoxicity.

CONTEXT: Carbon monoxide (CO) poisoning is the most common form of accidental lethal poisoning and is associated with a risk of brain damage in survivors. OBJECTIVE: The goal of this study was to examine whether Tau protein or S100B protein may be used as a biomarker for acute brain dysfunction. MATERIALS AND METHODS: The determination of Tau and S100B proteins was performed in serum samples collected from 27 CO-poisoned patients and 12 healthy volunteers. RESULTS: The level of Tau protein in the serum of patients (444 ± 227 ng L(-1)) differed significantly compared with those in the healthy controls (240 ± 61 ng L(-1)) and correlated with the level of carboxyhemoglobin. A higher concentration of Tau protein was found in patients who had lost consciousness during CO exposure. The concentration of S100B in the serum of CO-poisoned subjects (0.08 ± 0.03 µg L(-1)) was not statistically different from values obtained for the controls (0.07 ± 0.02 µg L(-1)). CONCLUSION: CO poisoning appears to be associated with an elevated level of Tau and S100B proteins in the serum of patients who had suffered a loss of consciousness. The study has shown that Tau protein is a more sensitive biomarker than S100B protein for the earlier stage of neurotoxic effects of CO intoxication.

Primary angioplasty in patient with ST-segment elevation myocardial infarction in the setting of intentional carbon monoxide poisoning.

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) due to coronary artery occlusion in the setting of acute carbon monoxide (CO) poisoning is a very rare presentation. OBJECTIVE: Our aim was to report on the use of primary angioplasty in a patient with STEMI in the setting of CO poisoning. CASE REPORT: A 36-year-old man with retrosternal chest pain was admitted after exposure to CO. The initial electrocardiogram (ECG) showed ST depression in I, aVL, and V3-V4 with slight ST elevation in II, III, aVF leads. Toxic carboxyhemoglobin level of 22% and troponin I of 2.19 µg/L were confirmed. After oxygen therapy the chest pain diminished, but after about 15 h it returned. The repeat ECG revealed normalization of previous ST depression with persistent ST elevation in II, III, aVF leads. The troponin I concentration was 5.94 µg/L. An echocardiogram demonstrated an apex hypokinesia involving the adjacent segments of the anterior and lateral wall. On the coronary angiogram, an acute occlusion of the distal left anterior descending coronary artery was confirmed. Primary percutaneous coronary intervention (PCI) of the infarct-related artery was performed. After PCI, the patient was symptom free and had partial ST-segment elevation resolution. The patient was discharged home after 7 days, with persistent ST-T changes and mild hypokinesia of the apex suggesting myocardial injury. CONCLUSIONS: Patients with toxic CO exposure who have symptoms of STEMI should be carefully evaluated with serial ECG, cardiac necrosis marker measurements, and an echocardiogram. When there is evidence of myocardial injury, a wider use of coronary angiography can identify patients who could benefit from PCI.

Acute CO poisoning is associated with impaired fibrinolysis and increased thrombin generation.

Carbon monoxide (CO) poisoning is a leading cause of unintentional poisoning deaths in many countries. In ex vivo studies, CO released from carbon monoxide-releasing molecules has been shown to attenuate fibrinolysis via increased alpha-2-antiplasmin activity. Hypofibrinolysis is associated with coronary ischaemia, which is also commonly observed in CO poisoning. We examined fibrin clot properties in acutely poisoned CO patients. Ex vivo plasma fibrin clot permeability, turbidimetry and efficiency of fibrinolysis were investigated in 48 patients and controls matched for age and sex. CO-poisoned patients had 11.6% longer clot lysis time than the controls (p < 0.0001). No intergroup differences in clot permeability or turbidimetric variables were observed. Plasma tissue-type plasminogen antigen (tPA), plasminogen activator inhibitor-1 (PAI-1) antigen and activity and F1.2 prothrombin fragments were higher in the patients than in the controls (all p < 0.0001). Plasma tPA activity was lower in the CO-poisoned group. Multiple linear regression showed that a thrombin generation marker, F1.2, is the strongest predictor of clot lysis time, followed by PAI-1 activity and carboxyhaemoglobin levels. In conclusion, this report is the first to demonstrate that acute CO poisoning in human beings is linked to increased thrombin generation and impaired fibrinolysis, which might contribute to ischaemic complications.

[Estimation of carbon monoxide poisonings frequency, based on carboxyhemoglobin determinations performed in Toxicology Laboratory in Krakow in years 2002-2010]. / Ocena czestosci zatruc tlenkiem wegla na podstawie wyników oznaczen karboksyhemoglobiny przeprowadzonych w Pracowni Toksykologii w Krakowie w latach 2002-2010.

Carboxyhemoglobin is a specific biomarker of carbon monoxide (CO) exposition. The source of CO indoors are most often gas, oil or carbon furnaces and stoves or bathroom gas heaters. CO intoxication during fire or exposition to car fumes are sporadic. The aim of the study was: to present the frequency of CO intoxications diagnosed in Laboratory of Analytical Toxicology UJ Collegium Medicum in years 2002 - 2010, to present the season trends of CO intoxications, show sex and age structure of CO intoxicated patients. Material were Laboratory of Analytical Toxicology and Drug Monitoring data records from years 2002 - 2010. CO intoxication was confirmed and recognized when COHb blood concentration was higher than 10%. Annual number of CO poisonings was stable in the period of time, varied from 209 to 296 (mean 256,2 CO poisonings per year). Sex structure of CO poisoned patients showed little female dominance (54.6%). Carbon monoxide poisonings distribution was seasonal. The season of intensified CO intoxications lasted from October to March, the highest intensity was in December and January. The CO poisoning problem is still actual. Society education about security, recognition, diagnosis and practice in carbon monoxide exposition is still needful.

[Acute clozapine poisonings in years 2007 - 2010 in material of Clinic of Toxicology in Kraków]. / Ostre zatrucia klozapina w materiale Kliniki Toksykologii w Krakowie z lat 2007 - 2010.

18 patients with acute clozapine poisoning, 6 female and 12 male, were analyzed. The mean age was 42.8 years. Six patients were intoxicated only clozapine. Mixed poisoning (clozapine and other factor) was diagnosed in nine cases. Among the additional factors dominated psychotropic drugs. According to the Poisoning Severity Score (PSS) criteria in the study group was only a one mild intoxication. Acute pneumonia developed in 3 patients, acute bronchitis and rabdomyolysis were reported in one case. The most common symptoms included: agitation, confusion (83.3%), tachycardia (77.8%), CNS depression (66.7%), excessive mucus production in bronchi, hypersalivation (44.4%), miosis (50%). Disordered breathing requiring intubation or mechanical ventilation occurred in 27.7% of poisoned. The average duration of hospitalization was less than 7 days.

[Drug-induced erythrodermia complicated by multiorgan failure--case report]. / Polekowa erytrodermia powiklana niewydolnoscia wielonarzadowa--opis przypadku.

Generalized erythroderma or exfoliative dermatitis, is a disease characterized by the appearance of erythematous and scaling skin changes, which often cover greater than 90% of the body's surface. The resulting failure of the skin can coexist with other organ failure and is potentially life threatening. We present a case of a young woman admitted with symptoms of erythrodermia complicated lung and liver failure. The patient's medical history in the first row pointed to the possibility of the coexistence of flu-like infection and drug-induced reactions by antibiotic (makrolide) and nonsteroidal anti-inflammatory drugs (acetaminophen, ibuprofen) therapy two weeks before hospitalization. Rapid progress of the disease and the degree of liver damage found to meet the criteria for liver transplantation for acute liver failure. However, the coexistence of pneumonia and transfusion-related acute lung injury (TRALI) were the reason to postpone transplantation until healing inflammation process and improving lung function. Standard medical therapy was extended by liver albumin dialysis (MARS) with gradual improvement of general state and complete resolution of symptoms. Differential diagnosis was performed and coexistence of other systemic and neoplastic diseases was excluded.

[Quantitative analysis of heart scintigraphy (99mTc-MIBI GSPECT) with regional myocardial wall motion and systolic thickening of left ventricle assessment for detecting myocardial damage in ethanol withdrawal patients]. / Zastosowanie analizy ilosciowej badania 99mTc-MIBI GSPECT z ocena odcinkowej ruchomosci scian i grubienia skurczowego miesnia lewej komory w aspekcie oceny stopnia uszkodzenia miesnia sercowego w zespole odstawiennym u chorych uzaleznionych od alkoholu--doniesienie wstepne.

Severe ethanol withdrawal syndrome, with psychosomatic symptoms, is life-threatening condition and if not treated can be fatal (in approximately 15% of cases). The purpose of this investigation was to assess cardiac muscle function using 99mTc-MIBI GSPECT in acute alcohol withdrawal. The group examined consisted of 10 males aged from 33 to 45 (45.7 +/- 8.82) because of alcohol withdrawal syndrome. The control group for quantitative analysis of the heart scintigraphy (GSPECT) consisted of 20 people referred for examination to the Laboratory of Nuclear Medicine, Jagiellonian University, which results of cardiac perfusion scintigraphy were assessed as normal. In acute withdrawal syndrome quantitative analysis of the heart scintigraphy (99mTc-MIBI GSPECT) revealed impaired regional wall motion and wall thickening related mainly to the lower wall segments. The abnormalities in myocardial perfusion (99mTc-MIBI GSPECT) was found in varying degrees of severity in all patients.

[Structure of psychoactive substances determined in medical toxicology laboratory]. / Struktura oznaczen substancji psychoaktywnych w szpitalnym laboratorium toksykologicznym.

Laboratory of Analytical Toxicology and Drug Monitoring, Jagiellonian University Medical College in Kraków performs analysis for patients from Kraków and south-east Poland. The determinations are made for intoxicated patients treated in the Toxicology Ward, for addicted patients treated in Detoxification Unit and other hospitals. The most often determined compounds are psychoactive substances (ethanol, drugs of abuse, psychotropic medicines). The purpose of the paper was to study structure of positive results of some psychoactive substances within seven years. In the study archived data of determinations registered in Laboratory of Analytical Toxicology and Drug Monitoring UJ MC in Kraków in the years 2002-2008 were used. The material was blood and urine samples collected for diagnostic of poisoned and addicted patients. There were used methods: EMIT (amphetamines, benzodiazepines, ecstasy, opiates, THC), FPIA (barbiturates, cocaine, tricyclic antidepressants (TCA)), colorimetric test (phenotiazines), thin layer chromatography (tramal). Annual mean numbers of positive results of psychoactive substances in the years 2002-2008 were: 411.7 for benzodiazepines, 234.1--amphetamines, 195.7--phenotiazines 168.4--opiates, 158.3--THC, 149.9 TCA, 87.9--barbiturates, 23.4--tramal 5.0--cocaine, 3.0--ecstasy. The structure and number of abused psychoactive substances determinations in 2002-2008 was studied. The numbers of positive results of benzodiazepines, amphetamines, THC and opiates were stable. The greatest increase of numbers of positive results was observed for cocaine and ecstasy in the studied period of time.

[Acute lethal poisoning with venlafaxine]. / Ostre, smiertelne zatrucie wenlafaksyna.

The case of acute venlafaxine poisoning with fatal outcome is shown. The 52-year-old woman with depression disorder ingested 56 pills of Symfaxin ER 150 venlafaxine as a suicidal attempt. Initially she was observed in the Neurology Department because of seizures, but after her husband found empty packages of medicine she was sent to the Toxicology Department being suspected of venlafaxine poisoning. The qualitative toxicological test confirmed the presence of venlafaxine in urine. In the course of poisoning rhabdomiolysis, hypotension and consecutive acute renal failure were observed. Finally, severe ventricular tachyarrhythmia occurred leading do cardiac arrest. Despite intensive symptomatic and supportive treatment the patient died.

[Stinging catfish spine envenamation]. / Narazenie na jad suma indyjskiego.

The stinging catfish Heteropneustes fossilis (Bloch, 1794) has become a popular aquarium fish in Poland and is available in almost every pet shop. The toxicological centers in Cracow, Gdansk and Warsaw have recorded twelve cases of envenomations caused by stinging catfish in the years 1994-2008. In most cases the injury was accompanied by oedema, erythema, intense pain, numbness of the site and dizziness. Schema of medical management was prepared using analysis of cases.

[Medical treatment during fish envenomation]. / Postepowanie w zatruciu jadami ryb.

Expositions to fish venoms should be treated as a separate group of intoxications because of their different diagnostic procedure. Until now, there are over 220 venomous fish species described, but skin excretions are potentially toxic for humans. Cases of fish envenomations (37), consulted by Poison Information Centres in Poland, as well as described in literature and contained in Micromedex database were analyzed. The course of envenomation, medical management during exposition to venomous of Chondrichthyes and Osteichthyes, freshwater and marine fishes were resolved. Injuries caused by venoms fishes were similarly treated, usually symptomatic. Specific antivenoms are available only for two fish species. Each patient exposed to sting or bite should be examined and observed. If characteristic sings and symptoms of envenomation are present, proper medical management should be proceed.

[Amphetamine and its analogues determination in urine from patients hospitalized in the Department of Toxicology Jagiellonian University Collegium Medicum in Krakow]. / Oznaczanie amfetamin i ich zmodyfikowanych form w moczu pacjentów Kliniki Toksykologii UJ Collegium Medicum w Krakowie.

UNLABELLED: The most popular stimulant drugs in Poland are amphetamine and its analogues: ecstasy (MDMA) and methamphetamine (MA). The substances are usually determined by immunoassays (EMIT, FPIA, Rapid Tests) in medical, toxicological laboratories. The methods are not useful for identification of the substances. Chromatography methods are reference, confirmation methods that identify stimulant drugs in biological samples. The aim of the study was investigation of kinds of amphetamine derivatives abused by poisoned patients treated in the Clinic of Toxicology of the Jagiellonian University Collegium Medicum in Krakow. Materials for the study were urine samples collected from 46 patients. All the samples were positive for amphetamine presence by EMIT (cut off = 300nn/ mL). Amphetamine analogues were identified by high performance liquid chromatography with diode array detector (HPLC-DAD). Amphetamine alone was present in 54.3% samples; amphetamine and it's analogues (MDMA, MDA, MA) were present in 26.0%; MDA and MDMA (no amphetamine) were present in 19.5% samples. In one case no amphetamine neither its analogues were detected in the sample. The positive amphetamine EMIT result was caused by fenfluramine--the substance present in slimming product. CONCLUSIONS: the most often determined stimulant drug in the group of poisoned patients was amphetamine. The frequency of MDMA and MA intoxications were occasional and with probably increase. Immunoassay tests are useful for routine analysis in clinic laboratories but in some cases when the history is unreliable, confirmation analysis by reference method should be performed to identify the abused substance.

Catfish stings and the venom apparatus of the African catfish Clarias gariepinus (Burchell, 1822), and stinging catfish Heteropneustes fossilis (Bloch, 1794).

The ability of catfish to inflict extremely painful wounds with their pectoral and dorsal stings has been well known for many decades. The venom apparatus of the African catfish Clarias gariepinus (Burchell, 1822), and stinging catfish Heteropneustes fossilis (Bloch, 1794) is constituted by a single, sharp and stout sting immediately in front of the soft-rayed portion of the pectoral fins. The sting has well developed articulations, making it possible for it to become erect and locked. The toxicological centres in Poland have recorded 17 cases of envenomations caused by stinging catfish and African catfish; the injury was accompanied by intense pain, numbness of the site, dizziness, local oedema and erythema. In addition, systemic symptoms such as tachycardia, weakness and arterial hypotension were observed. The treatment of these injuries should include cleansing of the wound and surrounding area. Immersion of the wounded extremity in hot water (45 degrees C) was used for the pain control. An attempt to remove any spinal sheath or remnant must be undertaken. Antibiotic management depends on several factors: the age and immune status of the victim, the interval between injury and presentation, or the presence of a foreign body. The most serious long-term complications of sting envenomation involve infections.

[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.

[Evaluation of regional cerebral blood flow using 99mTc-ECD SPECT in ethanol dependent patients: pilot study]. / Ocena zaburzen regionalnego przeplywu mózgowego metoda tomografii emisyjnej Pojedynczego Fotonu z uiyciem 99mtc-ECD u pacjentów uzaleinionych od alkoholu: doniesienie wstepne.

UNLABELLED: The depressant actions of ethanol in the brain is known. SPECT is non invasive method to measure the regional cerebral blood flow (rCBF) and to evaluate indirectly the brain metabolism. The aim of the study is to evaluate morphologic and functional status of CNS using 99mTc-ECD SPECT in chronic alcoholics. MATERIAL AND METHODS: Examined group consisted of 18 male alcoholic patients aged from 28 to 52 years (x = 42.1 +/- 5.4) treated at the Ward of Toxicology and Environmental Diseaes (Detoxification Unit). Only patients without prior head injury, CNS inflammatory changes, epilepsy, migraine, diabetes mellitus or other systemic injury were included. Alcohol dependence was diagnosed according to ICD-10 criteria. The intensity of withdrawal syndrome was measured using CIWA-A scale. The regional cerebral blood flow (rCBF) was measured using 99mTc-ECD SPECT with the double head E.CAM Siemens gamma camera. The reference group, necessary to obtain a normal values for the gamma camera applied, consisted of 31 healthy subjects (33.32 +/- 10.99 y). RESULTS: The mean values of rCBF in all examined region of frontal and temporal lobes, and in basal ganglia bothsided were significantly lower in the group of alcoholic patients than in the control group. No significant difference between rCBF in occipital lobes except the occipital inferior region, and in parietal lobes except the parietal superior region. Symetrical hypoperfusion (rCBF-2SD) in the frontal lobes was stated in 11 (61.1%), in temporal lobes in 4 (22.2%), in parietal and occipital lobes in 3 (16.7%) of the patients examined. In 7 the patients examined rCBF disturbances in basal ganglia were found (bothsided in 4, leftsided in 2, and rightsided in 2 the patients). Focal rCBF changes in the parietal, frontal and temporal lobes localised mostly on the left hemisphere were stated in 27.8% of the alcoholics examined. In concusion, the metabolic disturbances and the brain morphological changes mostly in frontal and temporal lobes due to chronic alcoholism were detected in the pilot study. A further investigation on more numerous group of ethanol dependent patients and monitoring of the changes in alcoholics who maintain a long-term abstinence from alcohol is needed.

[Withdrawal syndrome complicated with heart left ventricle dysfunction in young woman addicted to alcohol]. / Uposledzenie czynnosci lewej komory serca jako powiklanie zespolu odstawiennego u mlodej kobiety uzaleznionej od alkoholu.

A case of 23-years old woman, addicted to alcohol and affected by depression, with functional heart disturbances is described. The heart left ventricle dysfunction developed after alcohol withdrawal. In ECG leads (V2-V6, I, II, aVL) symmetrical, negative T waves were present. Echocardio graphy revealed decreased left ventricle ejection fraction (LVEF=35%) and local abnormal contractility. The cardiomyocytes necrosis markers (CK-MB, troponin I) were negative. After several days the improvement of the heart function was observed (LEVF= 56%, improving of myocardium regional contractility). The rest scintigraphy of the heart (99mTc-MIBI GSPECT) was performed and its results corresponded with echocardiography revelations. The ECG changes improved during three weeks hospitalization, but were not normal on discharge.

[Carbamazepine hepatoxicity--a case report]. / Hepatotoksycznosc karbamazepiny--opis przypadku.

An acute liver damage with jaun. dice and biochemical abnormalities developed in 16-year-old adolescent, affected by chronic hepatitis B, after 3 years of carbamazepine therapy. The maximum bilirubin concentration in the blood was 445 micromol/L and the highest activity of AST, ALT, PA, GTP were noted, 648 U/L, 1497 U/L, 312 U/L, 85 U/L respectively. INR was 1.59. The blood ammonia level was elevated to 60.9 micromol/L. The carbamazepine treatment was stopped and laboratory parameters improved.

[Acute suicidal carbofuran poisoning--case report]. / Ostre samobójcze zatrucie karbofuranem--opis przypadku.

A case of 49 years old woman with acute, severe suicidal carbofuran poisoning is described. The lowest activity of AChE was 0 IU/L. Because carbamates lead to multiorgan damages, especially affect central nervous system, computer tomography of the brain (CT) and examination of regional cerebral blood flow (99mTc-ECD SPECT) were done. No pathological changes were found in CT. 99mTc-ECD SPECT performed on 14th day of hospitalization, revealed disturbed regional cer- ' ebral flow generally in frontal and occipital lobes. Results of neuropsychological examination were pathological too.