Showing papers in "Przegla̧d lekarski in 2005"

Intrauterine growth restriction

Abstract: Intrauterine growth restriction (IUGR) is found in 1-10% of all pregnancies, and among women with risk factors even twice often. It is connected to worse obstetric results, and its complications can arise long time after delivery. In the paper we described etiology, diagnostics and monitoring of IUGR and its consequences for the child and for the course of neonatal periode.

[Adipose tissue: a new endocrine organ].

Abstract: In the recent years we have begun to appreciate that adipose tissue is more than just a passive repository for excess energy It is a highly active endocrine organ secreting a range of bioactive peptides with both local and distant action collectively called 'adipokines' or 'adipose tissue hormones' They include leptin, adiponectin, resistin, acylation-stimulating protein (ASP), plasminogen activator inhibitor-1 (PAI-1), tumor necrosis factor alpha (TNFalpha), interleukin 6, and angiotensinogen Some of these are specific fat-related hormones that are involved in regulating energy homeostasis, carbohydrate and lipid metabolism, vascular homeostasis and immune response Moreover, the tissue is implicated in the metabolism of some steroid hormones Disturbances in adipokine production may have potential repercussions in the pathophysiology of obesity, insulin resistance, and dyslipidemia Reversal or alleviation of these changes seem to be a promising target for management of the mentioned disorders The objective of this review is to summarise the most important aspects of biology, actions and regulation of these hormones with a special emphasis on the most recent literature

What lessons can we learn from the Japanese sarin attacks

Abstract: On 27 June 1994 a Japanese terrorist group, Aum Shinrikyo, released sarin in Matsumoto. Some 600 people were exposed: 58 were admitted to six hospitals and all recovered: seven casualties living close to the sarin release died outside hospital. This release followed an earlier attempt by Aum Shinrikyo to use sarin to kill the head of a religious sect perceived as a threat. In December 1994, a former supporter of the group was murdered by Aum Shinrikyo using VX. On 20 March 1995, Aum Shinrikyo launched a coordinated attack using sarin on the Tokyo subway system. Over 5000 "casualties" sought medical attention of whom 984 were moderately poisoned and 54 were severely poisoned; 12 died. Despite some initial difficulties, Japanese emergency units and local hospitals were able to respond reasonably rapidly. Analysis of the events reveals a number of important lessons for authorities as well as physicians to consider when preparing for such incidents.

Nutritional status of the opiate dependent persons after 4 years of methadone maintenance treatment.

Abstract: The aim of the study was to evaluate the nutritional status of opiate dependent patients before and after 4 years of participation in the methadone maintenance treatment. The examinations were performed in 30 opiates addicted persons (7 women and 23 men). The initial examination (exam 1) was done during the patients qualification for the methadone program, preceding methadone administration and final examination (exam 2) after 4 years of the treatment. In order to estimate the nutritional status body mass, the height, the arm circumference and the thickness of the triceps and subscapular fat-skin folds were measured. On the basis of them the BMI and mid arm muscle circumference (MAMC) were counted. The measurements of the body composition (using the bioimpedance method) were performed. The changes between the results of subsequent examination were tested using the t-Student test. In the examination that took place after 4 years of follow-up, body weight loss in the group of women was observed (mean--1.7 kg). It was followed by the decrease of BMI value (from 20.3 to 19.8 kg/m2). In both examinations the percentage of fatty tissue in general body mass was significantly below recommended values (10.7% in both examinations--the recommended values are 20%-22%). In the group of men an increase in body weight (mean--8.8 kg) and BMI value (from 23.3 to 25.9 kg/m2) was noticed. Arm circumference, muscle arm circumference and fat-skin folds values were increased. The analysis of particular body components showed increased fatty body mass (11.9% in the first and 18.5% in the second examination--the recommended values 16-19%) together with the decrease of lean body mass and body water.

Assessment of daily nutrition ratios of opiate-dependent persons before and after 4 years of methadone maintenance treatment.

Abstract: The aim of the study was the evaluation of the changes in nutritional habits of opiates dependent persons during 4 years of attendance in methadone maintenance treatment conducted by the Department of Toxicology of CMUJ in Krakow. These criteria were fulfilled by 30 persons (23 males and 7 females). They were examined before the methadone treatment and after 4 years of treatment. During Initial and final examinations for each of examined person the 24-hour recall had been performed three times. The information about daily supply of main nutrients (proteins, fats, fatty acids, carbohydrates, dietary fibre, cholesterol), minerals (calcium, iron, phosphorus, zinc, sodium) and vitamins (vitamin A, B1, B2, niacin, C) were obtained. The results were compared with daily norms (N) recommended on the safe level of intake. The normal range was established on the level +/-10% of normal values (+/-10% N). The changes between the results of following examinations were tested by using the t-student test. After 4 years of methadone treatment an increase in energy, vitamins, minerals and main nutritional ingredients intake was noted in women group. In men group a decrease in energy, proteins and carbohydrates intake was noted and fats intake, mainly unsaturated fatty acids, was increased. Vitamins were consumed in lower amounts and among minerals lower consumption in case of iron and sodium was noticed. In comparison with the recommended values in the initial examination in women group too low intake concerned fibre and vit. A, B,, calcium, iron, zinc and magnesium was noticed. In group of men too low intake (below recommended values) of energy, carbohydrates, fiber, vit. B1, B2, C, niacin, calcium and magnesium was noticed. After 4 years of methadone maintenance treatment in group of women too low intake only of vit. B1 and iron was noticed. In group of men it concerned vit. B1, B2, C, niacin and minerals such as calcium, iron, magnesium and zinc.

[Prevalence of diabetes, antidiabetic treatment and chronic diabetic complications reported by general practitioners].

Abstract: Introduction Prevalence of type 2 diabetes has increased greatly over the past decade and focus of care for people with diabetes has shifted from specialists to general practitioners (GPs). Because of lack of the central registry, a real number of diagnosed diabetes in Poland is unknown, as unknown is the prevalence of diabetes in patients attending primary health care, provided treatment and a prevalence of chronic diabetic complications registered by GPs. Aim of study Assessment of the prevalence of diabetes registered in primary health care, recommended antidiabetic treatment and prevalence of microangiopathic diabetic complications diagnosed by GPs. Material and methods Study was performed in Szczecin, a city of 450 000 inhabitants, located in North-West part of Poland. Data were obtained in year 2002 from one of the primary health care centers, in which health care was provided by 12 GPs for 27 932 inhabitants (15655 females and 12277 males), aged 0-98 years (average 38.3 +/- 23.2 years). Data were extracted from medical records and provided by GP doctors. Results Number of diagnosed and registered diabetics was 993 (prevalence--3.56%), age 3-95 years (mean 65.4 +/- 13.6 years). The diabetic group consisted of 611 females (mean age 67.5 +/- 12.4)--prevalence--3.90% and 382 males (mean age 62.0 +/- 14.7)--prevalence--3.11% (p = 0.003). Mean duration of diabetes was 7.4 +/- 6.9 years and it was similar for males and females. Type 2 diabetes was diagnosed in 94.4%, type 1 diabetes in 4.5%, other types of diabetes in 1.1% of all patients. Prevalence of registered diabetes in the group of 0-10 years old was 0.08%, in the group 11-20 years--0.33%, 21-30 years--0.25%, 31-40 years--0.44%, 41-50 years--1.93%, 51-60 years--5.03%, 61-70 years--9.88% and in the group over 70 years old--14.37%. Prevalence of diabetes in the group over 14 years old was 4.38%, in the group over 20 years--4.86%, and in subjects older than 35 years--6.84%. Elderly patients, over 60 years account for 74% of all diabetic subjects and subjects over 70 years--for 45% of them. Reported treatment of type 2 diabetes: diet alone--9%, oral agents--68%, oral agents combined with insulin--10.5%, insulin alone--12.5%. Mean HbA1c value measured in 307 type 2 diabetic subjects was 7.25 +/- 1.28%. According to GPs' opinion chronic microangiopathic diabetes complications were present in 36.6% of type 2 diabetic subjects. Retinopathy was reported in 24.8% of patients, polyneuropathy in 2.4%, nephropathy in 1.5%, diabetic foot in 0.5%, and combination of different complications in 7.4% of them. In type 1 diabetes chronic diabetic complications were stated in 42.2% of subjects--retinopathy--in 15.6%, polyneuropathy--in 2.2%, nephropathy--in 2.2%, diabetic foot--in 2.2%, and combination of them--in 20.0%. Average number of registered diabetics was 83 per physician, however 6 doctors took care of 107-158 diabetic subjects. In the past year diabetologist consultation or hospitalisation in internal medicine unit was provided for 47% of type 2 diabetics and for 98% of type 1 diabetics. Conclusions 1. The prevalence of diabetes registered in primary health care in Szczecin is higher than expected on the basis of European data. 2. Low number of type 2 diabetics is treated with diet alone and quite high number is treated with insulin. 3. Low number of chronic diabetic complications reported by GPs, despite long duration of disease, indicates the necessity of special training in delivering care for diabetic people, diagnosis of diabetic complications, increased access to secondary care and better cooperation between primary and secondary care.

The relationship between suicidal attempts and menstrual cycle in women.

Abstract: The purpose of the study was to explore relationship between the menstrual cycle and suicidal attempts. A study was performed on 151 fertile females who were admitted to the Clinic of Internal Diseases and Acute Poisonings Medical University of Gdansk during the years 2002-2003 because of suicidal attempts. The inclusion criteria were as follows: fertility, regular menstrual cycle, lack of oral contraceptives, willingness to attend the follow up and willingness to see a psychiatrist. Using the anamnesis the patients were also grouped according to the menstrual cycle into menstrual, follicular, midcycle and luteal phase. According to psychiatric investigations every female was classified to the respective category: situational reaction, depression, schizophrenia, alcohol addiction and sociopathy. Severity of intoxication was classified according to Poisoning Severity Score (PSS). Statistical analysis was done with the use of chi-square test with Pearson correction. Suicidal attempts were the most frequent among females during menstrual phase. The most common diagnosis in females who have attempted suicide were situational reactions which dominated in patients aged 14-21 years. Among attempters with the psychiatric diagnosis of depression, schizophrenia and alcohol addiction the degree of poisoning was significantly more severe than in the patients with situational reaction.

[Adipokines: adiponectin, leptin, resistin and coronary heart disease risk].

Abstract: Visceral obesity is among the known risk factors of atherosclerotic cardiovascular diseases. As long as adipose tissue was considered only an inert store of excess energy, accumulated in triglycerides, explanation of the mechanisms causing increased cardiovascular risk in obesity was difficult. Finding that the adipose tissue is an active endocrine organ and that the adipokines secreted in it influence several metabolic processes, allowed better understanding of this correlation. Several disturbances in secretion, function and balance of adipokines occur in the course of obesity. Changes of adiponectin, leptin and resistin concentrations are among the reasons of accelerated atherosclerosis occurring in the visceral adiposity. Adiponectin concentrations are decreased in visceral adiposity. Adiponectin is adipokine possessing antiatherogenic properties. It's effects exerted though the specific receptors in skeletal muscles and liver include decreased insulin resistance and improved plasma lipid profile. Acting directly in the vessel wall adiponectin prevents development of atheromatic lesions by inhibiting production of adhesive molecules and formation of foam cells. It has been found that decreased adiponectin concentrations are connected not only with increased coronary risk but also with progression of atherosclerosis in coronary vessels. Moreover it was found that adiponectin plasma concentration is significantly decreased in acute coronary incidences. Leptin regulates energy metabolism and balance. The concentrations of this adipokine are increased in obesity and correlate with insulin resistance. Hiperleptinemia has been also recognized as cardiovascular diseases risk factor. Resistin is considered to be a substance increasing insulin resistance, however the exact mechanisms are not known. Resistin plasma concentrations are increased in obese subjects and correlate with the inflammatory state that underlies the initiation and progression of atherosclerotic lesions. Correlation between resistin concentration and the extent of atherosclerotic plaques in the coronary vessels has also been found. The disturbances in secretion, function and balance of adiponectin, leptin and resistin are to be considered not only a link between visceral adiposity and cardiovascular risk but also independent risk factor of coronary heart disease.

The influence of cigarette smoking on sperm quality of male smokers and nonsmokers in infertile couples

Abstract: In this prospective study we investigated different semen parameters of infertile smokers with a history of cigarette smoking. 27 infertile men who smoked cigarettes, 79 infertile men who were nonsmokers and 82 healthy nonsmoking donors were evaluated. Smokers had significantly less spermatozoa with motility grade B (9.37% versus 11.9%, p 0.05), which can also suggests oxidative imbalance in the ejaculates of these men. No differences were found in the assessment of sperm concentration, motility grade A, C, D, percentage normal forms and different sperm defects, induced acrosomal reaction and acidic aniline blue staining test between these two groups (p>0.05). Our data demonstrate that cigarette smoking alters semen quality which could worsen fertilizing capability in infertile men.

Poisonings resulting from the ingestion of magic mushrooms in Kraków.

Abstract: Hallucinogenic mushrooms, also called "magic mushrooms", are becoming a more frequent cause of abuse, especially among young people, who use them experimentally for recreational purposes. In the autumn of 2004, several people were admitted to and observed in the Department of Clinical Toxicology in Krakow after they had used magic mushrooms to experience hallucinatory sensations. Three of them had visual hallucinations, and the fourth experienced both visual and auditory hallucinations followed by the exogenous psychosis after use of Psilocybe semilanceata. One person was hospitalised for several days while the others were observed in the emergency department. The main source of information for patients about hallucinogenic mushrooms was the internet. In the cases discussed the mushroom poisoning caused no organ damage and the symptoms disappeared in about 6 hours.

Date-rape drugs scene in Poland.

Abstract: Since the beginnings of twenty-first century in Poland increasing number of reports about the drug-facilitated sexual assaults have been observed. Many drugs have been identified as so-called "date-rape drugs", because of their pharmacological properties, especially inducing amnesia. These drugs are used for the purpose of "drugging" unsuspected victims and than raping them. In a typical scenario, the perpetrator surreptitiously adds "date-rape drug" to the alcoholic or non-alcoholic beverage of an unsuspecting person, who is subsequently sexually assaulted while under the influence of this substance. Many victims do not report the incident until several days after the event or even do not report it at all. They report the incident so late after the events because they often have problems with remember the course of incident. It causes that victim is not reliable witness for justice. Detection of "date-rape drugs" in biological fluids is unequivocal evidence of perpetration. Analysis of biological fluids collected from victims of rapes for presence of drugs was rare in Poland up to now. The aim of this study is to show the use of "date-rape drugs" in Poland. Materials for this study were from the routine casework elaborated at the Institute of Forensic Research in Krakow. APCI-LC-MS methods were applied for screening of biological fluids (blood and/or urine) for amphetamine and its 6 analogues, for 12 substances from benzodiazepine group and for quantification of the detected drugs. HPLC-DAD was used as a screening method for wide range of medicinal drugs, and NCI-GC-MS methods for determination of ketamine and tetrahydrocannabinols (delta9-tetrahydrocannabinol, 9THC) and its metabolite (11-nor-carboxy-delta9-tetrahydrocannabinol, THCCOOH). In 2000-2004, the biological fluids taken from 33 persons, both sexually assaulted or perpetrators were analysed. In 2000 and 2002 not any case of this type was registered, in 2001 only two cases were recorded. After 2003 significant increase in the number of these cases was observed. Eleven and twenty cases involving "date-rape drugs" were submitted to the Institute in 2003 and 2004, respectively. The most common substances detected in analysed materials were amphetamine (in concentrations ranged from 10 to 85 ng/ml) and 9THC (0.36-1.4 ng/ml). Alcohol (0.27-2.3% per hundred), MDMA (8-201 ng/ml), benzodiazepines (oxazepam, nordazepam, estazolam), propranolol and lidocaine were also found in blood and urine specimens.

[Overweight and obesity as common risk factors for gestational diabetes mellitus (GDM), perinatal macrosomy in offspring and type-2 diabetes in mothers].

Abstract: UNLABELLED Gestational diabetes mellitus (GDM) affects about 5% of all pregnancies and results in an increased incidence of Caesarean sections, perinatal traumas and neonatal complications. Macrosomy, i.e., an excessive birth-weight is observed in newborns from these pregnancies. In the majority of cases, diabetes regression is observed directly after pregnancy termination, however, in 15-60% of these patients, diabetes mellitus develops in later years of life. The goal of the study was an assessment of the risk factors for GDM development in gestation, perinatal macrosomy in offspring from GDM-affected pregnancies and overt diabetes mellitus in women after GDM. MATERIAL AND METHODS. The study involved 146 women with GDM and 1806 women with normal carbohydrate metabolism during pregnancy, 506 newborns of gestational diabetic mothers and 993 newborns of healthy mothers, as well as 200 women with a history of GDM during the years 1990-1999 (the mean time period after GDM - 3.1 +/- 6.0 years). The recognized risk factors of GDM and perinatal macrosomy were evaluated, together with the incidence of overt diabetes mellitus after GDM-affected pregnancy. RESULTS An analysis of multifactor logistic regression demonstrated that the independent risk factors for GDM include: BMI 3 25 kg/m2 before pregnancy (OR - 2.38), the history of diabetes in family (OR - 1.67), and the third pr further pregnancy (OR - 1.81) - p 0.05. Perinatal macrosomy correlated with mother's BMI and glycaemia during the 2nd hour of diagnostic test (75 g OGTT). No correlations were observed among mother's age, fasting glycaemia levels and HbA1c in mothers. In the group of GDM-affected women, diabetes mellitus type 2 was diagnosed in 34 (17.0%) patients. The the actual BMI > 25 kg/m2 and glycaemia values in the 2nd hour of diagnostic test in the course of GDM diagnosis (p 0.05 CONCLUSIONS Overweight and obesity are both risk factors of gestational diabetes mellitus, delivery of child with macrosomy features and of overt diabetes mellitus later in life.

Pregnancy in women with systemic lupus erythematosus (SLE)

Abstract: This paper presents the view of literature on pregnancy in systemic lupus erythematosus. It includes opinions on the risk of lupus exacerbation during the pregnancy. Despite much researches, it was not possible to give a precise answer to the question whether pregnancy induces increased rate of lupus flare. The women suffering from SLE face higher risk of fetal losses, preterm births or intrauterine growth retardations. However, if the pregnancy is properly planned and under interdisciplinary medical care, it is highly possible, besides exceptional cases, to give birth to a healthy child. Most of the authors do not advise against pregnancy with lupus patients.

Influence of tobacco smoking on lipase activity in patients with pancreatitis

Abstract: The aim of this study is to prove the influence of tobacco smoking on lipase activity in the blood of smoking and non-smoking health persons and in smoking and non-smoking patients with diagnosed acute (AP), chronic exaggerated (CEP) and chronic pancreatitis (CP). The blood has been collected from 28 healthy persons and 55 patients with AP, CEP and CP. The enzyme activity has been determined using the colorimetric method with substrate 1,2-odilauryl-rac-glycero-3-glutaric acid -(6-methylresorufin) ester. The exposures to tobacco smoke have been examined on the basic of concentration of cotinine in the serum of patients. The highest lipase activity has been found in smoking patients with CEP. It has been noted that the serum lipase activity is significantly higher in smoking and healthy persons (p 0.01; p>0.05 respectively) when compared to non-smoking patients. Results of examination indicate that tobacco smoking has a significant influence on exocrine function of pancreas.

Patient satisfaction as the main indicator of primary care quality

Abstract: Patient satisfaction is increasingly considered to be one of the most important factors in the measurement of quality of medical care. In the paper we show the most important aspects of patient satisfaction and the main reasons for its lack. We also suggest the possibilities of measurement and improvement of patient satisfaction as the main factor of better clinical care and a properly functioning family doctor.

Acute suicidal self-poisonings during pregnancy.

Abstract: Selected clinical aspects of suicidal attempts during pregnancy were presented Nineteen pregnant females, in the age range 17-27 (mean 22 +/- 258), were admitted to the Clinic of Acute Poisonings in Gdansk and Toxicological Ward in Poznan? between 2001 and 2004 because of acute suicidal intoxication The main attention was put on reasons of self-intoxication, the timing of attempted suicide as well as the influence of intoxication on the mother and the child For most admitters it was their first pregnancy (12 cases, 632%) The week of pregnancy varied from 4 to 37 (mean 19 +/- 93) weeks The most popular drugs for attempting suicide among pregnant females were benzodiazepines (7 cases, 368%) The most often reason of suicidal attempts was unplanned pregnancy (9 cases, 474%) There were two miscarriages and one premature birth observed in our cases Acute self-poisonings during pregnancy appeared to be a relatively marginal problem in the analyzed toxicology clinics and occurred in merely 038% of all women hospitalized between 2001 and 2004 in both clinics The main reason of suicidal attempts in pregnant women was unplanned pregnancy (9 cases, 474%) None of the studied females admitted that the main reason of suicidal attempt was an abortion induction

Proinflammatory cytokines in children with idiopathic headache

Abstract: OBJECTIVES The pathogenesis of primary headaches is differential, with a neurogenic inflammation participation. THE AIM The aim of this research was to establish whether inflammation participates in the pathogenesis of migraine and tension-type headaches (ETTH). In order to establish this, the levels of interleukin-6 (IL-6), interleukin-1 beta (IL-1beta), tumor necrosis factor (TNF) and soluble TNF receptor type I (sTNFRI) were detected in groups with headaches during headache-free interval and in controls and in the blood of children with idiopathic headaches to detect changes during headache attack. MATERIAL AND METHODS 30 children with migraine were included (16 with aura and 14 without aura), 17 boys and 13 girls aged 10-17 years (mean 13.5). The group with ETTH consisted of 31 patients, 24 girls and 7 boys, aged 6-17 years (mean 13.5). The control group, 28 children without headache, diagnosed with non-inflammatory orthopedic diseases, consisted of 15 boys and 13 girls, aged 7-17 years (mean 13.0). When the pain started during hospitalization, the blood was sampled in the first hour of the headache, then 3 hours and 6 hours since headache started (if headache persisted), and 6 hours after its termination. Two days after the pain termination, the blood samples were collected in children suffering from headaches, as the headache-free measurements and in controls under the same conditions at 7 a.m. after awakening. The cytokine level was established using Biosource kits, all 326 samples were processed. The statistical assessment was conducted. RESULTS No differences were detected in cytokine levels between the groups with migraine and ETTH and with comparison to controls during headache-free interval and during headache attack as well. However, it was established that in 12/30 children with migraine there was a significant increase in IL-6 level in the first hour of the migraine attack. This group consisted of 12 children with TNF level higher and the tendency toward decrease in sTNFRI was established, 3 hours since headache started, as compared to 18/30 children with migraine but without increase in IL-6. The correlation between the level of cytokines and age and weight was not detected. Also no correlation was established between cytokine levels and leukocyte and thrombocyte count. CONCLUSION 1. Changes of the level of IL-6, IL-1beta, TNF and sTNFRI in the blood of children with idiopathic headache do not indicate a significant role of inflammatory process in its pathogenesis. 2. Although the significant increase in IL-6 levels observed in several children in the first hour of the migraine attack may suggest that neurogenic inflammation participates in the pathogenesis of migraine.

Genetic polymorphisms of GSTM1 and GSTT1 in mothers of children with isolated cleft lip with or without cleft palate

Abstract: Orofacial clefts are one of the most common developmental malformations (OMIM #119530, #119540), which aetiology is very complex and associated with both genetic and environmental factors. One of the main environmental factors increasing the risk of having a child with an oral cleft is maternal cigarette smoking. The effect of maternal smoking may be modified by genes involved in biotransformation of toxic compounds derived from tobacco. Very important role in this process is played by S-glutathione transferase M1 (GSTM1) and S-glutathione transferase T1 (GSTT1) which conjugate glutathione with xenobiotics and promote their removal from human body. The aim of this study was frequency analysis of homozygous deletion of GSTM1 and GSTT1 genes in women having infants with ororfacial clefts and in control group. In this case-control study we used DNA isolated from peripheral blood lymphocytes of 121 mothers having children with isolated cleft lip with or without cleft palate and from 80 control mothers. The common deletions of GSTM1 and GSTT1 were determined by polymerase chain reaction and agarose gel separation. The prevalence of genotype GSTM1(-)/GSTT1(-) was higher in mothers of children with cleft (6.6%) compared to controls (3.7%, p>0.05). Among multiparous mothers of children with cleft (one child with birth defect and at least 2 healthy children, mean number of children - 4) the prevalence of genotype GSTM1(+)/GSTTI(+) was significantly reduced (31.0% vs. 58.7%, p=0.011). A significantly increased risk of giving birth to a child with cleft was found in multiparous subgroup of mothers with GSTM1(-)/GSTT1(-) and GSTM1(-)/ GSTT1(+) genotypes as compared to those with GSTM1(+)IGSTT1(+) genotype (OR 6.96; 95%CI: 1.33-36.57, p<0.01 i 3.05; 95%CI: 1.153-8.05, p<0.02 respectively). We did not observe a significant correlation between smoking status, GSTM1/GSTT1 genotypes and risk of orofacial clefts. Our results suggest that homozygous deletions of GSTM1 and GSTT1 in mother genome might increase the risk of having child with cleft lip with or without cleft palate.

Molecular adsorbent recirculating system--MARS as a bridge to liver transplantation in amanita phalloides intoxication.

Abstract: UNLABELLED A case of a 46-year-old female intoxicated with Amanita phalloides was presented. Since constant deterioration of her liver function she was put on the waiting list for urgent liver transplantation. To improve her clinical condition two sessions of Molecular Adsorbent Recirculating System were provided with transient good results. About 72 hours after the mushroom ingestion the patient had undergone liver transplantation. CONCLUSIONS Despite good clinical condition the patients severely poisoned with Amanita phalloides should be placed on a waiting list for liver transplantation as early as possible. The Molecular Adsorbent Recirculating System should be introduced as soon as possible after Amanita phalloides intoxication. Albumin dialysis may be considered as a bridge for the liver transplantation in patients intoxicated with Amanita phalloides.

[Liver albumin dialysis (MARS)--treatment of choice in Amanita phalloides poisoning?].

Abstract: UNLABELLED Amanita phalloides is a direct life-threatening poisoning because of acute multiorgan failure. Urgent liver transplantation (LTx) is the last chance to save patient's life in severe cases. In many cases of mushroom poisoning the patient dies because of unavailability of a liver graft. Liver albumin dialysis (MARS) is a promising treatment to bridge the patient to LTx or stabilize his or her condition until spontaneous liver regeneration occurs. CASE REPORT Four family members (father, mother and two sons) were eating self-collected mushrooms (Russula vesca). Typically for the Amanita phalloides poisoning, the first symptoms appeared in all persons more than 12 hours after mushroom ingestion. Because they did not improve, the whole family was admitted to the Regional Hospital in Ketrzyn (24 hours after mushroom ingestion). Mycological examination of gastric washings was positive only in the mother, in whom the Amanita phalloides spores were found. During the first 48 hours of poisoning the biochemical indexes of liver injury were observed in all persons. The whole family members were sent to centers where liver albumin dialysis could be performed: the mother was admitted to the Department of Nephrology and Dialysis Therapy in Olsztyn, the father and the first son were admitted to the Clinical Toxicology Department in Krak6w, and the second son was admitted to the Department of Internal Medicine and Acute Poisonings in Gdansk. Three albumin dialysis procedures were performed in the case of mother with complete liver recovery. After the first liver albumin dialysis, the father of the family was disqualified from the following procedures because of severe coagulation disturbances (GI bleeding), and died the fourth day after mushroom ingestion. The first son fulfilled the King's College criteria and was accepted for high urgency liver transplantation. After two albumin dialysis procedures had been able and the patient was urgently sent to the Department of General and Transplantation Surgery in Szczecin, where liver transplantation was successfully performed. The second son was treated conservatively with improvement of general condition and biochemical indexes and no albumin dialysis procedure was necessary. CONCLUSION Liver albumin dialysis may be effective in severe Amanita phalloides poisoning to stabilize the condition of a patient until spontaneous liver regeneration occurs or as a bridge to LTx. In cases of a family poisoning, proper coordination and cooperation among toxicology departments and transplant centers is required.

Mortality rate in acute poisoning in a pediatric toxicology department.

Abstract: INTRODUCTION: Acute poisoning, an important health issue in children can result in some cases in severe evolution and even death. OBJECTIVE: The aim of the study is to analyze cases of death caused by acute poisoning which occurred in a ten-year-period in a Pediatric Toxicology Department in Bucharest. METHODS: For the purpose of the study all medical records of the deceased patients with acute poisoning between 1995-2004 were analyzed with particular focus on the following criteria: etiology, age, social environment, type of intoxication (unintentional or intentional). RESULTS: Between 1995-2004, 46 fatal cases were recorded out of a total 8802 cases of acute poisoning (0.52%). The main two causes of death by acute poisoning were: caustics (16 cases--34.78%) and mushrooms (12 cases--26.08%), followed by carbon monoxide (7 cases 15.11%), pharmaceuticals (5 cases--10.86%), ethanol (2 cases--4.34%), pesticides (2 cases--4.34%), nitrites (1 case--2.17%) and lead tetraethyl (1 case--2.17%). CONCLUSIONS: Although morbidity in acute poisoning is still high, mortality is low, the registered average being 0.52%. The main agents causing death are caustics and mushrooms, and the most affected age group is that between 1 and 5 years of age.

Recreational amitriptyline abuse.

Abstract: UNLABELLED: Amitriptyline is a potent anticholinergics, rarely used as a drug of abuse. Two cases of amitriptyline dependency lasting for almost twelve months were described. According to the patients the abuse with amitriptyline guarantee them safety not to be uncovered by parents and doctors who systematically checked their urine with typical narcotic tests. CASE REPORT: Two patients with a history of abuse with amphetamine and clonazepam were admitted to the Clinic because of intoxication with amitriptyline. They denied the suicidal attempt and explained that they used amitriptyline in a dosage of 100 to 200 mg per day as a drug of abuse. On the day of admission one of the patients had increased the dosage up to 600 mg which caused an acute intoxication. CONCLUSION: Antidepressants should be treated as a drugs with possible abuse ability.

Tetrahydrocannabinols in clinical and forensic toxicology.

Abstract: Cannabinoids are the natural constituents of marihuana (cannabis). The main of them are delta9-tetrahydrocannabinol (9THC)--psychoactive agent, cannabinol (CBN) and cannabidiol (CBD). Cannabis is administered either by smoking or orally. 9THC potency and duration of action as well as its and two of its major metabolites concentrations in organism highly depend on the route of administration. A single active dose of 9THC is estimated on 520 mg. 9THC is rapidly metabolised. It is hydroxylated to an active metabolite, I1 -hydroxy-delta9-tetrahydro-cannabinol (11-OH-THC), then oxidised to an inactive 11-nor-9-carboxy-delta9-tetrahydrocannabinol (THCCOOH), which is conjugated with glucuronic acid and predominantly excreted in the urine. The maximum psychological effect persists for 4-6 h after administration despite of very low 9THC blood concentrations. 9THC plasma concentration declined to values of 2-3 ng/ml during 3-4 h after smoking. Such a low concentration of the active compound in human organism create a demand for use of sensitive analytical methods for detection and determination of 9THC and its metabolites. The most effective techniques for 9THC and related compounds determination in biological material are chromatographic ones (gas and liquid) with mass spectrometric detection and different ionization modes. 9THC and its two metabolites (11-OH-THC and THCCOOH) are present in blood and hair, 9THC in saliva, and THCCOOH in urine. 9THC and related compounds are determined in autopsy material, although deaths by overdose of cannabis are exceptionally rare. Fatalities happen most often after intravenous injection of hashish oil. 9THC and its metabolites determination in different biological materials gives the basis for a wide interpretation of analytical results for clinical and forensic toxicology purposes.

The changes in taste preferences during 4 years period of methadone maintenance treatment.

Abstract: The aim of the study was the analysis of the changes in the kind and the frequency of particular nutritional products consumption by opiate addicted persons during 4-year lasting methadone programme. There were 30 opiate addicted patients under examination (23 men and 7 women). Food consumption quality was estimated with the use of the Intake Frequency of Food Products Questionnaire. The examinations were performed before methadone administration had started, after 9 months and after 4 years of methadone maintenance treatment. Three categories of consumption frequency were established: rarely, moderately and often. The classification of different products was done with the use of hierarchic cluster analysis. For general illustration of the data the consumed products were compared by the means of hierarchical cluster analysis (this was done with the help of Euclidean distances and the Ward's algorithm). Then the k-means (with k=3) method was used in order to identify groups of products that were similarly often consumed. Each k-means analysis was performed separately for each examination. This was done in order to find out the products that change the cluster from one examination to another. Twenty labile products were identified. The examined products were moving between the adherent categories. This means that the consumption pattern undergoes some changes over the course of methadone therapy. Additionally, the analysis of the diet of this group of people shows improper and unhealthy nutritional behaviours: too big intake of sweets and too low intake of complex carbohydrates, fish and vegetable fats. This was especially visible at the beginning of the therapy, later this unfavourable diet habits changed but not to the desired level.

Proinflammatory cytokines in children with migraine with or without aura

Abstract: OBJECTIVES Migraine is an idiopathic headache of differential pathogenesis. THE AIM The aim of this research was to establish whether the pathogenesis of migraine with or without aura is identical. In order to examine this, the differences in the level of interleukin-6 (IL-6), interleukin-1beta (IL-1beta), tumor necrosis factor (TNF) and soluble TNF receptor type I (sTNFRI) were established during a migraine attack with or without aura in children. MATERIALS AND METHODS 30 children with migraine were included, 17 boys and 13 girls aged 10-17 (mean 13.5). In 14/30 children migraine without aura was diagnosed, in 16/30 with aura, visual in 12 and sensory in 4 children. The headache duration was in 23 children shorter and in 7 children longer than 6 hours. When the pain started during hospitalization, the blood was sampled in the first hour of the headache, then 3 hours and 6 hours since headache started (if headache persisted), and 6 hours after its termination. Two days after pain termination, the blood samples were collected, as the headache-free measurements. The levels of IL-6, IL-1 beta, TNF and sTNFRI were established using Biosource kits, all 146 samples were processed. The statistical assessment was conducted. RESULTS The significant differences in cytokine levels were detected between children with migraine with or without aura. During headache-free interval in children without aura the level of IL1-beta was higher than with aura (p = 0.03), during 1st hour of migraine attack as well (p = 0.046). Higher, but non significant was IL-1 beta level 3 hours since headache started and 6 hours after its termination (p = 0.06). Type of migraine influenced also the TNF level (in children with migraine without aura higher 6 hours after pain termination, p = 0.046) and sTNFRI (p = 0.07 during the same period). The differences in IL-6 levels between children with migraine with or without aura were not significant. CONCLUSION 1. The significant increase in IL-1beta level observed during headache-free interval and early stage of attack of migraine without aura as compared to migraine with aura may reflect differences in pathogenesis of both types of migraine in developmental age. 2. This dissimilarity may be suggested also by the increase in TNF and sTNFRI levels in children with migraine without aura as compared to children with migraine with aura after pain termination.

Transbronchial needle aspiration as a diagnostic method of mediastinal adenopathy

Abstract: The aim of the study was to assess the diagnostic yield of transbronchial needle aspiration (TBNA) in mediastinal or hilar adenopathy in: sarcoidosis, tuberculosis and malignancy Transbronchial needle aspiration was performed in 53 patients, preeceded by computed tomography (CT) In 22 patients (41,5%) TBNA enabled to diagnose 10 cases of sarcoidosis, 12 cases of neoplastic infiltrates of the lung There were 31 cases undiagnosed by means of TBNA In 24 patients the diagnosis was established by means of other methods like bronchoscopy with mucose biopsy (8 cases of sarcoidosis), transbronchial lung biopsy (4 cases of squamous cell carcinoma and adenocarcinoma, 2 cases of sarcoidosis), mediastinoscopy (3 cases of sarcoidosis and 2 cases of Hodgkin's disease), and videothoracoscopy (2 cases of sarcoidosis), transthoracic needle biopsy (1 case of squamous cell carcinoma) and lymph node biopsy (1 case of adenocarcinoma and 1 case of sarcoidosis) In the remaining 7 patients who were followed-up for a period of one year the diagnosis of sarcoidosis was confirmed by clinical, radiological and cytological (BAL) examinations Transbronchial needle aspiration was shown to be efficient diagnostic method in mediastinal or hilar adenopathy in sarcoidosis and malignancy except lymphoma Moreover in approximately 60% of cases this technique doesn't allow to establish a diagnosis and in turn implicates the necessity for further diagnostic procedures like mediastinoscopy, or transbronchial or thoracoscopic lung biopsy

Suicide and suicide attempts in adolescents and young adults in Kraków in the years 2002-2003.

Abstract: The aim of the study was to present the increasingly alarming phenomenon of completed suicide in adolescents and young adults. The material analysed had been drawn from the records of post-mortem examinations conducted by the Institute of Forensic Medicine in Krakow. The analysis covered cases of completed suicide committed by 15-30 years old inhabitants of Krakow or its environs between the September 2002 and the September 2003. The group of subjects analysed comprised 47 individuals (9 females and 38 males); 57.4% of these had resided in a big city (Krakow), and the remaining 42.6%--in villages or little towns near Krakow. The data regarding cases of completed suicide were compared with the data regarding suicide attempts by self-intoxication in the period under consideration, extracted from the documentation of the Department of Clinical Toxicology in Krakow. The latter data encompassed 233 cases of suicide attempts by individuals ranging in age from 15 to 29 years, with females constituting 62.2% of these, and males--37.8%. 65% of the attempters had been residents of Krakow. The analysis of the data from the Institute of Forensic Medicine revealed that nearly half of the suicide victims concerned had been treated for mental disorders, mainly depression and addictive disorders. The occurrence of suicide attempts prior to the fatal act was established in the case of 17 subjects (18.5%). Over half of the subjects (48.9%) committed suicide by hanging themselves, 17%--by falling from a height, 8.6%--by drowning, and 19.1%--by self-intoxication with medicaments. 77.2% of the subjects committed suicide at home. In the case of 23 subjects (48.9%), the post-mortem examination revealed the presence of alcohol. The analysis of the cases of suicide attempts by self-intoxication revealed a significant percentage of depressive disorders (26%)--of high occurrence especially in the case of females, whereas alcohol addiction was the predominant diagnosis in the case of males. Furthermore, the majority of the attempters exhibited situational reactions or personality disorders. Suicide attempts constitute an essential part of the issue of suicide in adolescents and young adults and require further research. What attracts notice, is a high percentage of males among suicide victims, and a high percentage of suicide victims with earlier suicide attempts. The results of the study should be taken into consideration in suicide prevention in groups especially endangered by the risk of completed suicide, such as adolescents and young adults after suicide attempts.

[Herbs and herbal preparations applied in the treatment of gastric hyperacidity, gastric and duodenal ulcer in cigarette smokers].

Abstract: The origins of gastric hyperacidity, gastric and duodenal ulcer appearance includes genetic predisposition, incorrect diet and unbalanced lifestyle, e.g. increased stress level, cigarette smoking. Herbal drugs have been proved to be very effective in treatment of hyperacidity, gastric and duodenal ulcer. They can be applied as drugs supplementing or enhancing the activity of synthetic medicines. Moreover, herbal drugs have been successfully applied inprophylactic of hyperacidity, gastric and duodenal ulcer. Herbal therapeutic preparations are administered as infusions from individual herbs, from mixtures of herbs, tinctures, herbal preparations. The most often used herbs include mucus: Lini semen, Psylli semen, Foenugraeci semen, Althaeae radix/folium, Sinapis albae semen; antiphlogistic volatile-oils: Chamomillae anthodium, Millefolii herba, moreover Glycyrrhizae radix, Aloe gel.

Fentanyl and its analogues in clinical and forensic toxicology.

Abstract: Fentanyl and its analogues are commonly named synthetic opiates. Some compounds from fentanyl group (e.g. fentanyl, alfentanil, sufentanil, remifentanil) are used as anaesthetic and analgesic of high potency and short duration of action. Effects of acting fentanyls are indistinguishable from those produced by nasal inhalation of street heroin. In view of this, fentanyls are very "attractive" for the narcotic market. In least years an increase in number of reports about illegal production and non-medical use of fentanyl and its analogues have appeared. Numerous fentanyl analogues are sold under one name synthetic heroine or China white. Fentanyl and its analogues also can be used as gas warfare agents. One of fentanyl-related compound was used during action of easing hostages from Dubrovka theatre. Because of respiratory depression, which was caused by used compound, died over 100 hostages. Because of high potency fentanyl-related compounds are used in very low doses. So fentanyls appear in biological material in very low concentrations, not higher than several nanograms per millilitre or per gram. The drugs in these concentrations cannot be detected by means of routinely used screening procedures. Therefore direct methods for determination of this group of compounds are needed. Screening method for determination of fentanyl and its analogues was elaborated and validated. Liquid chromatography-mass spectrometry (LC/MS) technique was applied. The method is characterised by the limit of quantification (LOQ) and the limit of detection (LOD) ranged from 0.6 to 2 ng/ml and from 0.2 to 0.6 ng/ml, respectively for four above-mentioned compounds. The method was used for determination of fentanyl in three forensic cases. The blood, bile and blood from lung samples were taken during autopsy of persons who died shortly after surgical procedure in which fentanyl was used as an adjunct to general anaesthesia.

[Alexithymia and depression: relationship to cigarette smoking, nicotine dependence and motivation to quit smoking].

Abstract: The aim of the study was to examine an alexithymia score and depression among people smoking cigarettes and also to examine association between alexithymia, depression and smoking index, nicotine addiction, the motivation to quit smoking. The study comprised 46 people from Warsaw and its environs, without pulmonary, cardiovascular or neoplastic diseases, with at least medium education. The subjects were qualified into two groups: group I (n = 22) - subjects who had never smoked cigarettes, and group II - currently smoking (n=24). The total alexithymia score and scores of alexithymia subscales: difficulty in identifying feelings (TIE), b) difficulty in communicating feelings (TOU), c) externally oriented thinking (OSM) were assessed with Toronto Alexi. thymia Scale 20 (TAS-20). Beck Depression Inventory (Scale) (BDI) was used to evaluate presence and intensification of depression symptoms. The tobacco addiction rate was assessed with the Fagestrom questionnaire, and the motivation to quit smoking with the Schneider test. All data were obtained during individual exami. nations. The mean alexithymia score in the nonsmokers group was 38.6+/-8.8, in the smokers group: 46.6+/-13.0. The differences between the groups were statistically significant (p=0.02). Both difficulty in identifying feelings (TIE) and difficulty in communicating feelings (TOU) scores were significantly higher in the smokers (TIE p=0.01; TOU p=0.03). There were no differences in externally oriented thinking. It was found that people smoking cigarettes had a significantly higher level of intensification of depression symptoms than the controls. There was not any correlation between the total alexithymia score and depression symptoms or smoking index, the degree of nicotine addiction, the motivation to quit smoking.