[Cardiovascular disturbances in acute poisoning--mechanisms and management]. / Zaburzenia sercowo-naczyniowe w ostrych zatruciach--mechanizm i postepowanie.

The authors present the most common in clinical toxicology cardiovascular disturbances and mechanism of action the selected drugs (tricyclic antidepressants, cardiac glycosides, beta-blocking agents and calcium channel blockers). General management in acute poisoning with these drugs is also presented, concerning their toxicodynamics.

Usefulness of rest and forced perfusion scintigraphy (SPECT) to evaluate cardiotoxicity in acute carbon monoxide poisoning.

The aim of the study was to evaluate myocardial perfusion in acute carbon monoxide poisoned patients using rest and stress Tc 99m-MIBI SPECT scintigraphy. There were 29 study patients (15 men and 14 women) aged from 14 to 46 years poisoned acutely with CO at home. Measurement of COHb, blood lactate level, duration of exposure and ECG examination were performed on admission to the Clinic. The enzymes activity (ALT, AST, CBK) were evaluated after 24 hours. The first rest Tc99m-MIBI SPECT was performed in all patients two to five days after intoxication. Fifteen of the patients underwent the control examination: stress and rest scintigraphy six months after CO exposure. Moving track exercise according to the Bruce protocol was used in each the patients. The control rest scintigraphy was performed 48 hours after exercise. Abnormal, differently intensified scans were noted in all the subjects: 5 patients had a I degree of pathological changes, 7 patients had II degree, 16--III degree and 1 patient had a IV degree of pathological changes. In 14 of the patients with pathological scintigraphic scans the normal EKG curves were noted. The mean COHb level was 35.0 +/- 7.22%, the blood lactate concentration was 4.4 +/- 3.7 mmol/L. The average duration of exposure was 108.4 +/- 163.9 min. Effort related ischemia was not noted in 10 of the patients who underwent control examination. An improvement in rest scintigraphic scans was stated in 12, and no changes were observed in 3 of the controlled patients. Deterioration was not found in any patient. No correlation between ECG results and scintigraphic image of myocardium was found. Tc 99m-MIBI SPECT scintigraphy is a more sensitive method than electrocardiography and measurement of enzymes activity for the evaluation of CO cardiotoxicity in acute poisoning. The method enables evaluation of the localization and disease extent.

The influence of acute poisoning with an organophosphate compound on the regulation of breathing and the respiratory system efficiency.

The female patient, aged 40, was admitted to the Department of Toxicology about fifteen hours after she had drunk 50 ml Basudin 25 EC (diazinon contents 25%) in a suicidal attempt. On admission the patients state was described as moderately severe (9 points). Starting with the first day after the poisoning, the functional state of the respiratory system was monitored. Ventilation efficiency was determined on the basis of the results from a flow-volume curve, spirometry and the measurements of the respiratory tract resistance (Rrs) in a computerised system Lungtest-MES company (Poland). Respiratory regulation was evaluated by means of synchronic measurements of the respiratory pattern and occlusion pressure. The results obtained from a respiratory pattern and P 0.1 were refereed to normal values. In the examination carried out directly after the poisoning slight obturation of the central bronchi and elevation in resistance of respiratory tract was noted. After a week, obturation was not noted and the resistance value was better. Also the respiratory pattern parameters and value of occlusion pressure were better. It seems that in this case the increase in resistance values in the respiratory tract should be related to the increased activity in the parasympathetic system. Basic, traditional spirometric even in the examination on the first day after the poisoning, were within normal limits, while the parameters of respiratory pattern, occlusion pressure and respiratory resistance were beyond the norm. The results obtained from the measurements of respiratory pattern parameters correlated well with the clinical condition of the patient and with the results of biochemical and enzymatic measurements.

The usefulness of carboxyhemoglobin, methemoglobin and blood lactate concentration in evaluating the health condition of Kraków inhabitants exposed to primary pollutants.

Determination of the carboxyhemoglobin (COHb), methemoglobin (MetHb), and blood lactate concentrations is known as important contributive in evaluation of oxygen deficiency in people from urban populations. The methemoglobinemia is usually caused by unfavourable impact of NOx. A quantification of COHb allows, to some extend, to evaluate the threat of population with carbon monoxide (CO). An elevation in the blood lactate concentration indicate the oxygen insufficiency of the examined patients. The aim of this study was to evaluate the concentrations of the mentioned parameters in the three groups Kraków's population differently exposed to CO produced by incomplete combustion of carbon-containing materials. The group I consisted of 53 patients treated at the Toxicological Department for acute CO poisoning. The group II comprised 31 subjects professionally exposed to CO. The group III comprised 99 adult Kraków's inhabitants who started education in the technical school and had never been professionally exposed to CO (control group). The elevation in methemoglobin concentration was not found in any of the examined group. The highest COHb level was noted in the group of the acute CO poisoned patients. No significant difference between COHb levels was found in the chronically exposed group (II) and in the control one. The increased blood lactate concentrations were found in both the acutely CO poisoned and in the group of chronically, by occupation, exposed to CO. No unfavourable impact of Nox reflected in methemoglobinemia was noted in any examined population. The determination of COHb levels is helpful in diagnosis of acute CO poisoning. The measuring of the blood lactate concentration allows to detect the oxygen insufficiency in acute CO poisoning and in states of long-term exposure to CO.

The assessment of the condition of the liver in patients chronically exposed to mercury compounds in the place of settlement.

Problems with the assessment of organ damage caused by toxic substances in places of residence have recently appeared with increasing frequency. In spite of this there have been so far no uniform, objective research methods which could allow their accurate evaluation. This is why the attempt has been made to assess morphological and functional condition of the liver in patients chronically exposed to mercury compounds in the place of settlement. The research group consisted of 62 patients exposed to metallic mercury at a yearly rate exceeding 24 kg for average duration of 16 years. Patients with the liver or biliary tract diseases, symptoms of chronic circulatory insufficiency, Australia (HBs+) antigen carriers and alcoholics were excluded from the research group. The control group consisted of 29 males. AST and ALT activity, prothrombin level, bilirubin and protein concentration in blood serum were measured and scintigraphic and USG examinations of the liver were performed. Mercury concentrations were also established. Scintigraphic examination yielded an abnormal image of the liver in 52% of the exposed patients. The differences in frequency and intensity of scintigraphic changes in comparison with the control group were of statistical significance. No pathological changes were found in USG examination. Significantly higher ALT activity and bilirubin concentration and significantly lower total protein concentration were found in the exposed group. The correlation between the intensity of scintigraphic changes and mercury concentration were noted. Liver scintigraphic examination combined with biochemical analysis allows an assessment of the liver condition in chronic exposure to mercury compounds in the place of settlement.

Thermoregulatory dysfunction secondary to acute ethanol poisoning.

Acute ethanol poisoning followed by drugs of abuse and psychiatric disorders is the most common cause of hypothermia. An attempt to evaluate the ethanol poisoning degree considering body temperature, serum osmolality, osmolal gap and ethanol concentration measurements was the aim of study. The lowest body temperature measured using infrared tympanic thermometer--First Temp Genius, Sherwood Medical was noted in the severely poisoned patients and was well correlated with the serum osmolality and with the osmolal gap.

[Risk factors of ischemic heart disease in various occupational groups. II. Complex analysis of risk factors]. / Czynniki ryzyka choroby niedokrwiennej serca w róznych grupach zawodowych. II. Kompleksowa analiza czynników ryzyka.

Four hundred four men aged 30 to 59 years, belonging to one of 4 occupational groups were investigated in a standard clinical conditions. Two from those groups were characteristic for steel mill professions: 121 blast furnace workers; exerting strenuous physical effort and working in hot microclimate. 131 operators (the second group) performed work in comfort microclimate conditions not demanding much effort. The third group comprised 73 executives of industry. The fourth group consisted of 79 monks. For all subjects of investigations 8 selected risk factors of ischemic heart disease were evaluated. They included: age, sex, family history, habit of smoking, systolic blood pressure, fasting blood cholesterol level, obesity index and professional physical activity. The level of each risk factor had numerical value in a span from "0" to "8". The sum of all points was decisive to which of 3 groups of risk given man should be accounted. Those 3 groups were arbitrary divided into "low, intermediate and high risk". The highest risk was found for the executives group, and the lowest for blast furnace workers. From the risk factors under investigation highest overall influence on incidence of ischemic heart disease had habit of smoking and obesity. Described here point classification system seems to be very simple and useful for estimation of risk of ischemic heart disease in a given population.