[Alcohol related hospitalization in the Department of Clinical Toxicology and Medicine Detoxification Ward of the Krakow Special Hospital of J. Babinski in Krakow]. / Alkohol jako przyczyna hospitalizacji w Klinice Toksykologii Collegium Medicum UJ i Oddziale Detoksykacji Szpitala Specjalistycznego im. J. Babinskiego w Krakowie.

The patients hospitalised because of acute ethanol intoxication or ethanol withdrawal syndrome at the Kraków Department of Clinical Toxicology and Detoxification Ward of J. Babinski Specialistic Hospital in the years 1997-2000 were subjected to the study. A significant increase in number of ethanol related hospitalisation was noted at the Department of Clinical Toxicology (from 1381 patients in year 1997 up to 1771 in year 2000), and at the Detoxification Ward of Babinski Hospital from 369 in 1997 and 849 patients in 2000 respectively. A significant increase in number of ethanol dependent patients admitted to the Department of Clinical Toxicology because of acute ethanol intoxication and the patients hospitalised because of ethanol withdrawal syndrome or signs of delirium tremens was noted. The same and even stronger trends in hospitalisation, particularly of those ethanol addicts presenting clinical symptoms of acute ethanol intoxication were observed at the Detoxification Ward of Babinski Hospital.

[Diagnosis of ethanol dependence using the CAGE and SAAST questionnaire in selected therapeutic populations]. / Rozpoznawanie uzaleznienia alkoholowego przy pomocy kwestionariuszy CAGE i SAAST w wybranych populacjach terapeutycznych.

An diagnosing of ethanol dependence, despite of clear ICD 10 criteria, in patients treated particularly at the toxicological and detoxication wards, but also in other hospital wards is still a difficult task. Several questionnaires have been developed for easier detection of symptoms, the way of drinking and also for economic, family and medical effects of ethanol drinking in examined patients. A high sensitivity and specificity of CAGE and SAAST questionnaires allowing to identify problem drinkers or alcohol dependence in 192 patients of Kraków Department of Toxicology and 475 patients of Detoxification Unit was stated in the study. The CAGE questionnaire has allowed to identify the possibly ethanol dependence in group of 74 patients hospitalized at the Ward of Internal Diseases and Dialysis of Town Hospital in Sieradz, because of illness, that were not connected with alcohol drinking.

[The kind of dependence and estimation of body mass]. / Rodzaj uzaleznienia a skladowe masy ciala.

The aim of the study was to evaluate frequency of overweight and underweight, and estimation of components of body mass (body fat, lean body mass, body water) in 176 people: 61 men with aethanol dependency (group 1), 37 opiate addicted men (group 2), 32 men in control group (group 3), 14 opiate addicted women (group 4) and 32 women after first suicidal attempts who were treated in the Department of Clinical Toxicology (group 5). All of the patients had their Body Mass Index (BMI) calculated. The components of body mass were calculated using the method of bioelectrical impendance with Maltron. Statistical analysis was performed using the Statistica Software. The greatest differences were observed between group 2 and group 1. In both groups more underweight, less overweight with less total body fat was observed, with the increase in body water. In both women groups no overweight or obesity were observed, but there were significant differences between various body components masses. Deficiencies in body fat were observed in 86% women from group 4 and in 50% women from group 5. On the other hand excess of body water was observed in 93% from group 4 and only in 47% from group 5. Our studies shown that even among the persons with correct weight calculated using the BMI method some abnormalities can be observed in body fat, lean body mass and body water. We therefore conclude that only by measuring components of total body mass we may evaluate etiology of overweight and obesity.

[A trial for the complex risk assessment of repeated suicide predictors in patients after suicidal poisoning attempts, hospitalized in the Department of Clinical Toxicology CM UJ in Krakow. I. Influence of socio-demographic factors]. / Próba kompleksowej oceny predyktorów ryzyka ponowienia samobójstwa u pacjentów po samobójczym zatruciu lekami, hospitalizowanych w Klinice Toksykologii CM UJ w Krakowie. Czesc I. Wplyw czynników socjodemograficznych.

The study included 180 patients aged 18-79 (average 36) hospitalized for suicide attempts (drug intoxication) in Department of Clinical Toxicology CMUJ from March to December 2000. Examined group was composed of 49 men and 131 women. Structured investigation and medical documentation were used to estimate crucial socio-demographic risk factors of repeated suicide attempt. The following socio-demographic traits were taken into consideration in analysis: age, sex, marital status, place of living, education, employment, family background. We distinguished among patients under examinations: patients after first suicide attempt (I) and group after another suicidal attempt (II). The second group consisted of 15 men (27.8% of the total) and 39 women (72.2% of the total). Young people under 30 constituted 37.2% of the whole examined population. In population of women after repeated suicide attempt the percentage of divorced ones increased considerably (from 2.2% to 10.2%). Both in men and women after repeated suicide attempt the percentage of persons with only elementary education increased (from 34.1% to 53.7%). We observed high unemployment rate (from 26.6% to 29.6%) in both groups. Percentage of pensioners increased from 23.5% after first suicidal attempt to 33.3% after repeated suicidal attempt in men and from 25.5% to 35.9% in women. Men after repeated suicide attempt more often live with their parents, while women from the second group more often live alone with their children. It seems that some of the analysed predictors which are expression of social unadjustment may make risk factor for repeated suicidal attempts.

[A trial for the complex risk assessment of repeated suicide predictors in patients after suicidal poisoning attempts, hospitalized in the Department of Clinical Toxicology CM UJ in Krakow. II. Clinical predictors]. / Próba kompleksowej oceny predyktorów ryzyka ponowienia samobójstwa u pacjentów po samobójczym zatruciu lekami, hospitalizowanych w Klinice Toksykologii CM UJ w Krakowie. Czesc II. Predyktory kliniczne.

The study included 180 patients aged 18-79 (average 36) hospitalized for suicide attempts (drug intoxi-cations) in the Department of Clinical Toxicology CM UJ from March to December 2000. Examined group was composed of 49 men and 131 women. The following tests were used in this study: structured questionnaire, psychological tests: Beck Depression Inventory, Hamilton Depression Scale, Hopelessness Scale, Suicidal Intent Scale, Life Events Scale, SOC 29 (by Antonovsky). Besides, we used data from patients' history. The aim of our study is to analyse clinical data of suicidal attempters--after first and repeated suicidal attempts. We took into consideration the severity of coma, severity of intoxication, the kind of substances used in the attempt, the presence of alcohol, previous psychiatric treatment, cases of suicide among the patients' close friends or relatives and duration of hospitalization. Then the psychiatric diagnosis was stated. The analysis of severity of intoxication (divided into three stages: severe, moderate, and light according to the Poisoning Severity Score (PSS) indicated that in the group of repeated suicide attempters the percentage of severe intoxications was greater (9.2%) then in first time attempters. In the population of second time female attempters there is a greater percentage of persons who took neuroleptics (15.4%) compared to group first attempters (5.4%). In both groups the majority were taking anxiolytisc, sleep-inducing and mixed drugs. There was a greater percentage of persons drinking alcohol during the attempt among repeated suicidal attempters (38.8%) than among the first time attempters (26%). The percentage of persons with diagnosis of mental disease (treated in ambulatory or in hospital) is higher in the group of repeated suicide attempters (25.9%) then after first attempters (6.3%). In both groups a lot of persons had reactive depression, often associated with personality disorders, rarely endogenic depressions or psychosis. We observed that addiction to alcohol is often a problem in men who attempt suicide (I group--32.3%, II group--33.3%). The analysis of medical documentation indicated in the group of repeated suicide attempters a high percentage of people with cases of suicide among their close friends or relatives.

[The sense of coherence and risk of suicide attempt]. / Poziom poczucia koherencji a ryzyko próby samobójczej.

The analysis was based upon 79 patients hospitalized for suicide attempts (drug intoxication) in the Department of Clinical Toxicology CM UJ in Kraków from July to December 2000. The purpose of the study was to estimate the sense of coherence level (according to Antonovsky) as a potential suicide attempt predictor. The population of patients was divided into two groups: patients after first suicide attempt (I) and group after reattempting suicide (II). The examination was based on structure interview, analysis of medical documentation and a number of tests including SOC 29 (by Antonovsky), Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), and Beck Hopelessness Scale (HS 20). The most important psychological and independent variable measured in the study was the sense of coherence, introduced first by Aaron Antonovsky as a significant predictor of mental health. The sense of coherence (measured by SOC 29 questionnaire) comprises comprehensibility, manageability and meaningfulness. Both in foreign and in polish studies the SOC 29 level was lower in clinical groups compared to healthy people. The norm in Polish population was 139 scores in SOC 29. In the present study the average total result (men and women) was 112 scores in the group of patients after first suicide attempt, and in the group of repeated suicide attempters the average total result was even lower--only 99 scores, which makes a statistically significant difference. We also observed a statistically significant dependence between the results of SOC 20 questionnaire, the level of depression measured by Beck Depression Inventory and Hamilton Depression Scale, and the level of hopelessness measured by Beck Hopelessness Scale. The above results indicate that the sense of coherence level may make significant risk factor for repeated suicide attempt.

[Significance of subjective evaluation of life events as risk factors for predicting future suicide attempts]. / Znaczenie subiektywnej oceny wydarzen zyciowych jako czynników wplywajacych na ponowienie próby samobójczej.

Among the total population of 180 patients undergoing medical examination between March and December 2000, hospitalized for suicide attempts (drug intoxication) in the Department of Clinical Toxicology CM UJ in Kraków, 159 persons were examined by means of modified questionnaire of life events based on a scale elaborated by Thomas Holmes and Richard Rache. The patients were divided into 2 groups--first group comprised patients after first suicide attempt and second group consisted of those who had reattempted suicide. In regard to sex and age there were no significant differences between these two groups and the total population of 180 patients. In order to obtain the patients' subjective evaluation of the influence of their course of life on their attempting suicide, we asked the patients to select from the list of life events those that had affected their mental and physical state during of whole their life. Objectivization of life events was based on the 'units of life change' by T. Holmes and R. Rache. The sum of units of life events was 373 scores (SD +/- 200, in the range of 39-1042 units). From the total list of life events (max. score--1513) we selected the events estimated at 40 and more units of life change. Those were; marriage, divorce, separation, marital reconciliation, patient's illness, change of behavior and illness of a close relative, death of a husband/wife, child, close relative, imprisonment, pregnancy, unemployment, retirement. In the patients' subjective evaluation part, the events most frequently selected by the patients as those that had affected their mental state were: death of a close relative (56.6%), illness of a relative (40.8%), patient's illness (37.7%). A high number of patients stated events testifying to a conflict in marriage--45.7% of patients stated marital separation, and reconciliation, and 27% of patients stated unemployment as a fact that had influenced their mental state. 30.6% of these patients belonged to the first group (after first suicide attempt) and only 18.7% belonged to the second group (after repeated attempt). The authors of the study have presented a discussion over the results of the analysis and demonstrated the need for cultural adaptation of so that it can be effectively used in General Practitioners' training.

[Preliminary evaluation of methadone program in Kraków]. / Wstepna ocena programu metadonowego w Krakowie.

Methadone maintenance programs have effectively reduced opiate dependency and are available in many countries, also in Poland. In Kraków 50 persons were qualified to methadone maintenance treatment. Their age varied from 21 to 46 years, mean 27.8 years. Participants of the programme were mainly educated on basic technical level, unemployed, after 3 to 30 attempts of detoxification treatment. After initial observation at the Detoxification Unit of the Department of Clinical Toxicology and establishing effective daily oral dose of methadone, all patients in Outpatient Clinic of Abuse receive daily adequate dose of methadone, where in parallel, individual and group psychotherapy is used. Methadone programme which was applied seems to prove the fact, that it can significantly improve life quality of addicted patients as well as increase the level of public safety.

[Nutritional problems of persons qualified for the methadone treatment. Part I. Nutritional status of opiate addicts]. / Problemy zywieniowe osób zakwalifikowanych do leczenia substytucyjnego metadonem. Czesc I. Stan odzywienia osób uzaleznionych od opiatów.

The aim of the study was assessment of the nutritional status of opiate addicted persons. The study was carried out on 44 opiate abusers (14 women aged from 21-33 years and 30 men aged from 21-46 years), who were classified to methadone maintenance treatment. Nutritional status was assessed by anthropometry methods and body composition was examined using bioelectric impedance. BMI (body mass index) of examined women ranged from 16.4 to 30.8, and BMI of examined men ranged from 17.1 to 44.9. 21% of women and 44% of men had BMI < 15th centile (this indicates undernutrition), 7% of women and 3% of men had BMI > 85th centile (this indicates overnutrition). The medium body fat content for women was 8.7 +/- 6.3 kg (14.7% of body weight), for men 9.5 +/- 8.5 kg (11.9% of body weight). 50% of women and 53% of men had body fat deficiency upper 5% of range adjusted for age and sex, body fat excess upper 5% of range revealed 14% of women and 17% of men. The water content for examined women was 35.5 +/- 6.9 L (62.8 of body weight), for men 47.4 +/- 8.4 L (58.8% of body weight). Water deficiency upper 5% of range revealed 7% of men, 86% of women and 53% of men had water excess upper 5% of range. The lean body mass for women was 48.2% +/- 7.2 kg (85.4% of body weight), for men 62.7 +/- 10 kg (88.4% of body weight). Anthropometry as well as examination of body composition indicate prevalence of energy protein malnutrition among opiate addicted.

[Evaluation of carbon monoxide cardiotoxicity in group poisonings]. / Ocena kardiotoksycznego dzialania tlenku wegla w zatruciach zbiorowych.

The aim of the study was to estimate the usefulness of rest 99mTc-MIBI SPECT scintigraphy to evaluate carbon monoxide cardiotoxicity in acute group poisonings. There were 7 study patients (5 men and 2 women) aged from 14 to 35 years treated at the Department of Clinical Toxicology intoxicated with CO at three different sites: three persons were intoxicated at one, two persons at the second and the next two persons at another site of exposure. As derived from interview the circumstances, source and duration of exposure were similar within the separate group. This enables a comparison of clinical course of carbon monoxide poisoning, particularly the circulatory system of people who were simultaneously exposed to the same source of carbon monoxide. Measurement of COHb, blood lactate level, duration of exposure and ECG examination were performed on admission to the Clinic. The enzymes activity (ALT, AST, CPK) were evaluated after 24 hours. The rest 99mTc-MIBI SPECT scintigraphy was performed in all patients two to five days after intoxication. The changes in myocardial scans were graded according to the arbitrarily accepted point scale. Considering the results of ECG and enzymes activity only, no objective were found to diagnose the cardiac dysfunction. However the perfusion scintigraphy scans indicated regions of myocardium that have decreased blood flow in all the study patients.

The concentrations of nitrates and nitrites in food products and environment and the occurrence of acute toxic methemoglobinemias.

In the study it was intended to evaluate the concentration of nitrates and nitrites in some food products and samples of potable water collected in Kraków region and compile these results with frequency of recognised toxic methemoglobinemia cases. In the years 1991-1993 91 food samples, 288 samples of tap water from the central waterworks of Kraków and 399 samples of well-water from the country side of Kraków region were collected. In the chemical laboratories the nitrates and nitrites concentration has been defined. The clinical material of inpatients from 2 hospitals of Kraków and the data from the Poison Information Centre in Kraków have been analysed. The examined food samples did not present, in general, raised levels of nitrates and nitrites. Also the tap water samples presented a low concentration of these substances. The well-water samples demonstrated in considerable percentage increased levels of nitrates and nitrites and exceed the level permitted by sanitary law. In the Provincial Childrens Hospital during recent 14 years 8 infants with recognised methemoglobinemia were treated. All cases were connected with environmental pollution. At the Department of Toxicology, where only adults are treated, no methemoglobinemia cases resulting from environmental pollution during recent 26 years were hospitalized. The Poison Information Centre during recent 14 years consulted 239 cases of methemoglobinemia; 90% of them concerned children intoxicated because of environmental pollution.

Progress in the CT evaluation of the cerebral atrophy in acute poisoning with carbon monoxide.

The aim of the study was to evaluate the frequency of occurrence and intensification of the cerebral atrophy changes taking into consideration the age of the examined, in the course of acute poisoning with carbon monoxide. A modified Messe's method was used to evaluate brain atrophy. 111 patients intoxicated with carbon monoxide were examined using CT of brain. In 75% of them cerebral atrophy was stated. To evaluate a dynamics of changes a control CT examination was performed in 72 patients after a year.