Outcome of patients in acute poisoning with ethylene glycol--factors which may have influence on evolution.

INTRODUCTION: Intoxication with ethylene glycol occurs as a result of intentional ingestion in suicide attempts or accidentally. Clinical ethylene glycol poisoning is not specific and occurs in many poisoning cases therefore the diagnosis is difficult. Early diagnostic and establishment of therapy are very important for a favorable evolution. The mortality rate of ethylene glycol intoxication ranges between 1 and 22% depending on the amount of alcohol ingestion and the time period between alcohol ingestion and initiation of therapy. METHODS: Retrospectively analyzed data from 18 patients admitted with ethylene glycol poisoning in the emergency department between 2011 and 2012. The following were taken into consideration: incidence of intoxication in the group study, medical history, the amount ingested and the time since the ingestion of ethylene glycol and the admission to hospital, presence of metabolic acidosis and laboratory test results on admission (urea, creatinine osmolar or anion gaps), the treatment initiated and the outcome of the patient. RESULTS: 18 patients with ethylene glycol intoxication were admitted to hospital between 2011 and 2012. The initial diagnosis based on a detailed clinical history in combination with the presence of metabolic acidosis with elevation of the osmolar or anion gaps. 12 of the 18 patients were man (66%) and age range interval was between 23 and 77 years. The time from the ingestion of ethylene glycol and the admission to hospital was between 30 minutes and older than 24 hours. 14 patients have been presented earlier to the hospital, between 30 minutes and 12 hours (in the first part of the clinical stage) and 13 of the 14 patients had a favorable evolution. One of these patients had an unfavorable evolution. Regarding this patient, the amount ingested was unknown. 10 of the 18 patients had a voluntary ingestion (55,55%) and 6 of the 18 patients had an alcoholism medical history. The amount ingested by the patients was between 20 ml and 500 ml. Metabolic acidosis was present up to 55,55% (10 of the 18 patients) in the blood gas analysis on admission, with pH on admission between 6.9 and 7.27, with anion gap ranging between 16.3 mmol/l and 32.6 mmol/l (normal range 8-16 mmol/l). Ten patients also had an increased level of urea and creatinine with a level between 1.24 to 6.85 mg/dl for creatinine (normal range 0.5-1.2 mg/dl) and 49 to 98 mg/dl for urea (normal range 15-43 mg/dl) and developed acute kidney injury that required regular HD sessions. Mechanical ventilation was required for 7 of the 18 patients (38.88%). Five patients died (27.77%). Although metabolic acidosis was corrected under hemodialysis, there were patients who had multiple organ failure and systems: acute respiratory failure requiring ventilator support, acute renal failure requiring dialysis daily sessions, altered state of consciousness. CONCLUSIONS: The early diagnostic and exclusion of the other diseases and other poisoning led to a specific treatment of the intoxication. The time from the ingestion of ethylene glycol and the early establishment of therapy is very important for a favorable evolution and can prevent substantial mortality.

The effects of Zinc on human body, including on renal failure and renal transplantation.

Zinc (Zn) is an important element in human body and in the last period of time there were a lot of studies regarding its importance. It is significant for the good working of many organs. A special attention was given to the importance of the serum Zn in patients with renal failure. Among the micronutrients, zinc may rank with iron with regard to its importance for public health. This article reviews some epidemiological, clinical, diagnostic and therapeutic aspects of these conditions.

[Cryotherapy in ophthalmology]. / Crioterapia în oftalmologie.

This article is a general view of cryotherapy and its clinical applications in ophthalmology. The method of cryotherapy is used less after LASER therapy and EEC appearance in ophthalmology but remains a unique method in treatment of some disease and a very valuable choice to the modern techniques.

[Acute posterior or multifocal placoid pigment epitheliopathy]. / Epiteliopatia pigmentara placoida multifocala acuta.

The paper presents a clinical case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy and the specific diagnosis problems of this case. Being a less frequent disease the common aspects are emphasized as well as the latest concepts about this syndrome.

Computerized electroencephalographic, polysomnographic, transcranial ultrasound and morphopathological research in vertebro-basilar strokes.

This paper contains a clinical, classical electroencephalographic and computerized electroencephalographic (by original methods) study of 271 cases with vertebro-basilar strokes, all the cases being verified by transcranial Doppler ultrasound investigations and some of the patients by morphopathological studies. In the first part, the standard EEG modifications in relation with the clinical pictures and with the affected arterial field are presented. In the second part, the aspects of the computerized EEG recordings with the carrying out of the cortical EEG mappings which have brought important contributions in setting down the topography of the infarctions are discussed. The third part presents the results of the polysomnographic recordings of the 70 selected cases with ischaemic vertebro-basilar attacks without disorders of consciousness (32 cases), with attacks accompanied by symptomatic hypersomnias (13 cases), with ischaemic attacks accompanied by insomnia (5 cases) and with ischaemic attacks with disorders of consciousness (20 cases). The opinion of the authors on the possible relations between the disturbances of the vigilance, the perturbations of the polysomnographic organization of sleep-wakefulness cycles (with the realisation of some interesting competitive dysfunctions between the three states of vigilance) and the electrographic anomalies are discussed.

Electroclinical correlations in temporal lobe epilepsy.

2,698 epileptic patients were studied, 2,019 cases (64.3%) presenting temporal lobe epileptic attacks. Besides the routine EEG recordings and the corroboration of the clinical data with the meticulous observations by video monitoring on a closed circuit TV-screen (the patients being observe in a specially arranged room, provided with infra-red cameras), the diagnostic procedure was supported in all cases by several computerized EEG mappings, according to a model achieved by us, transcribing the primary data obtained by Hjorth's NSD parameters from the Siemens-Elema Mingograph to a Romanian M-118 microprocessor. In many cases we utilized an interface--built by us--for analog-digital conversion which allowed the direct introduction and conversion of amplitudes and frequencies from the Mingograph to the micro-computer. These were isolated to analyse the following electroclinical forms: 1. temporal absences: 360 cases (17.8%); 2. psychomotor attacks: 439 cases (21.7%) 3. psychosensory attacks: 77 cases (3.8%); 4. attacks with cognitive symptomatology: 260 cases (12.8%); 5. crises with ideative-affective symptomatology: 76 cases (3.8%); 6. vegetative attacks: 51 cases (2.5%); 7. akinetic attacks: 89 cases (4.4%); 8. focal temporal attacks secondarily generalized: 667 cases (33.0%). In 112 patients with nocturnal attacks, polysomnographic recordings were performed with sequential computerized EEG mappings during the various stages of sleep (concomitantly with the infrared video-TV monitoring).

Polysomnographical researches in patients with temporal lobe epilepsy.

One hundred and twelve patients with temporal lobe epilepsy were studied. Continuous polysomnographical recordings were performed for eight hours, the patients being video-monitored all the time. These researches, completed with computerized EEG cortical mappings demonstrated a peculiar activation of the temporal foci during REM phases and during some stages of LSWS.

Polysomnographic and computerized waking-sleep research in epileptic petit mal absences.

The authors carried out 8 hours of continuous night polysomnographic recordings in 40 selected cases with various forms of absences. In all these patients, the computerized electroencephalographic mappings were performed according to several methods achieved by the authors. The nocturnal electrographic abnormalities, the morphological patterns of the epileptic discharges during different sleep stages and the cortical computerized cartography were comparatively analysed in the five groups of patients: 1) genuine (pure, classical or simple) petit mal (PM) absences: 8 cases; 2) myoclonic PM absences: 10 cases; 3) amyotonic-akinetic PM absences: 6 cases; 4) "false" temporal epileptic absences: 10 cases; 5) "hybrid" (or "bastard") PM absences in 6 cases with Lennox-Gastaut disease.

Computerized electroencephalographic mapping in hypomagnesian spasmophilic syndromes.

Out of 397 patients presenting hypomagnesaemia there were selected for this study only 107 cases with neurotic and neuromuscular clinical picture (sometimes with short and simple loss of consciousness) without any sign of organic cerebral lesion. The dosing of the seric and erythrocytic magnesium was performed by means of a colorimetric method of Mann and Yoe, modified by the authors. In all the cases, the EEG and EMG changes were studied by simultaneous recording of the EEG and EMG before, during and after hyperpnoea. In these 107 selected cases (divided into three groups: children, adolescents and adults) the computerized electroencephalographic maps (CEM) were carried out by an original method, transcribing the primary data of Hjorth's NSD parameters (Amplitudes and Frequencies) into a Romanian M-118 microcomputer, by a technique with analog-digital conversion. The CEM (in white-black and in colour cartography) were performed for various epochs, including the sequential ones (second by second, all along the EEG discharges during and after hyperpnoea). By these methods, we analyzed the dynamic fluctuation and temporo-spatial cortical distribution of the sinusoidal slow waves generated by the reticulate neuronal hypersynchrony. The CEM showed some differences in the three groups of hypomagnesemic syndromes selected.

Effects of arginine vasotocin on REM sleep in narcoleptics and in symptomatic hypersomniacs.

Arginine vasotocin (AVT), in doses of 1.5 microgram, administered intranasally to two narcoleptics (a male aged 42 years and a female aged 35 years), as well as to 5 symptomatic hypersomniacs (3 females and 2 males), aged 25-57 years, induced very rapidly in most instances in sleep with REM periods at onset and markedly increased in amount of REM sleep during a fixed period of 180 min of sleep recording. After AVT administration there was a significant shortening of the time of occurrence of the first REM sleep period both in narcoleptics (t test = 0.05 greater than P greater than 0.025) and in symptomatic hypersomniacs (t test = 0.02 greater than P greater than 0.01).