[About paracetamol again]. / Ismét a paracetamolról.

The mechanism of hepatotoxicity caused by paracetamol (acetaminophen) overdose and the treatment of patients is reviewed. Paracetamol is widely used over-the-counter drug with analgesic and antipyretic properties. Although it is considered to be safe at therapeutic doses, the incidence of hepatotoxicity caused by overdose or inadvertent application has been increasing lately. N-acetyl-p-benzoquinonimine, one of the metabolites formed from paracetamol is responsible for the hepatotoxicity. Until now there is no complete therapeutic strategy for the effective treatment of hepatotoxicity caused by paracetamol. Gut decontamination, N-acetylcysteine antidote administration and enhancement of elimination is used for the management of paracetamol overdose. Those with severe hepatotoxicity and neurological symptoms can benefit from removal of necrotic liver and undergo transplantation.

[Snake bite injuries]. / Kígyómarás okozta sérülések.

Authors treated five patients who suffered venomous snake-bite injury. Although these snakes are not native in Hungary, this kind of injury is estimated to be more frequent, because of the increasing number of the private collections and illegal import of these reptiles. The local and general symptoms, the therapeutic steps are summarised in this study considering the literature as well. Two patients did not show any systemic or local symptoms at the level of injury, they needed only short observation, and woundcare. The other three patients had serious transient systematic symptoms (vasolability, hypotension/shock, coagulopathy, confusion). Two of them were given specific antivenom. As the third patient did not agree with the serum therapy, plasmapheresis was the choice to treat him, and it seemed to be effective. Few hours later the patients needed surgery because of serious compartment syndrome of their affected upper extremity. Surgical decompression of all the compartments and different possibilities of the secondary skin closure technique are demonstrated. Two patient healed completely, but the right thumb of the third was lost. Authors summarise the effects of the poisons, the symptoms, and the basic therapeutic steps during the first aid and in the primary hospital phase, respectively. They point out the indications of the serum therapy and the correct surgical decompression of the injured extremity.