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J Pach

Publications and source records attributed to J Pach.

At least 19 recordsLinked to original sources
PubMed1999

[Comparison between the poisoning severity score and specific grading scales used at the Department of Clinical Toxicology in Krakow].

The aim of the present study has been to assess the concordance in severity grading when using the Poisoning Severity Score (PSS), proposed by IPCS/EC/EAPCCT vs. some specific grading scales. Cases of acute poisoning admitted to the Department of Clinical Toxicology in Kraków during months January, March, May, July, August and October 1998 (n = 820) were evaluated. Severity grading was performed in all cases using both the PSS and special grading scales developed by the poisons centre in Kraków. The PSS is assessing severity on the basis of observed clinical signs and symptoms (at their maximum), but does not take into account potential risks or plasma/serum concentrations. The Kraków scales include both clinical symptoms on admission and results of toxicological analyses. Ethanol (39.4%), drugs (36.2%) and carbon monoxide (7.9%) were the most commonly involved toxic agents. Overall concordance between the PSS and the Kraków scales was at hand in 596 cases (72.7%). The lack of concordance was most evident for ethanol and carbon monoxide cases--the PSS generally giving a lower grade. The discordance was less pronounced for grade 3 (life-threatening) poisonings. Significant number of ethanol poisoning in Kraków centre require medicolegal certification thus ethanol concentration (blood or expired air) is considered while evaluating the poisoning severity. Moreover majority (more than 70%) of acutely ethanol poisoned patients treated at the Department are chronic alcoholics so clinical evidence of intoxication may be minimal at blood ethanol levels higher than 3.0 g/L. For ethanol intoxication the blood ethanol concentration was considered in the Kraków scale but not in the PSS, and when the blood concentrations were disregarded and clinical symptoms only were evaluated the concordance improved between the different systems from 72.7% to 92.3%. Thereby also the overall concordance in the study increased to 82.9%. The less satisfying concordance for carbon monoxide cases was mainly caused by discrepancies in the evaluation of neurological symptoms. Also the blood lactate concentration, COHb level, duration of exposure and patient's age are considered in the Kraków scale but not in PSS. The PSS is intended as a general scheme for grading severity of acute poisoning. In this study an acceptable concordance between the PSS and some locally developed grading scales was at hand in the majority of cases, but it seems that for specific poisons, like carbon monoxide, some modifications and additional criteria may be justified. Further studies to test the reliability of the PSS are encouraged.

Adult↗
PubMed1999

[Methods of poison elimination--controversies and actual views about their use].

This paper presents controversies and current ideas about application of poison elimination methods in acute poisonings. Indications and contra-indications for single dose of activated charcoal, gastric lavage, cathartics and whole bowel irrigation are discussed. Rationale and indications for forced diuresis, repeated doses of activated charcoal, hemodialysis and hemoperfusion, enhanced elimination methods, are described.

Charcoal↗
PubMed1999

[The usefulness of Aspargin for supplementing potassium and magnesium in ethanol dependent patients].

Intoxication with many xenobiotics cause serious electrolyte abnormalities which require intravenous supplementation. In chronic and acute but not very severe intoxication an oral supplementation of ions can be sufficient. The aim of the study was to evaluate the usefulness of Aspargin for supplementation of potassium and magnesium in chronic alcoholics suffering from withdrawal syndrome. There were 46 study patients, dependent on ethanol treated at the Detoxification Unit of the Department of Clinical Toxicology in Krak w. A differently intensified symptoms of ethanol withdrawal syndrome were noted according to CIWA-A scale in all the patients. Concentration of potassium and magnesium was monitored through the hospitalisation. Except a basic treatment (fluid supplementation, benzodiazepines) also Aspargin (three times a 2 tablets per day) was administered to each of patient for 7 to 10 days. No respiratory, muscular and gastrointestinal symptoms due to hypopotassemia and hypomagnesemia have been noted while hospitalisation in any patient so it could be suspected, that oral supplementation with Aspargin was sufficient to keep these ions balanced. Administration of Aspargin was beneficial to patient and the treatment outcome.

Administration, Oral↗
PubMed1998

[Positive and negative symptoms in chronic schizophrenic patients under maintenance therapy with flupenthixol decanoate for a twelve month perioid].

62 chronic schizophrenics, who after a psychotic exacerbation were stabilized again, were randomized on 3 different maintenance dosages of flupentixol-decanoate and observed for 12 months. 15 (24.2%) patients had a relapse independently of the dose. 34 of the 47 patients without relapse had complete documentations of the follow-up. After 3 to 6 months there was an obvious and constant clinical improvement as assessed by various test inventories. The BPRS-scores for psychopathology, negative and positive symptoms improved significantly between 14 to 18%. There was also significant reduction of negative symptoms assessed by SANS (22%) as well in the severity of illness (CGI) and an amelioration of psychosocial functioning (GAS, Strauss-Carpenter). At the end of trial 26.4% of the patients had mild involuntary movements (AIMS), 23.5% were on antiparkinson-medication. It is concluded that there could be an indication for flupentixol-decanoate in the long term maintenance therapy especially of chronic schizophrenics with negative symptoms and problems of compliance under oral medication.

Adult↗
PubMed1998

[Evaluation of carbon monoxide cardiotoxicity in group poisonings].

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.

Adolescent↗
PubMed1998

[Neurologic sequelae in severe carbon monoxide poisoning--case report].

The symptoms and clinical course of severe acute poisoning with carbon monoxide in 22-years-old man is described. To evaluate neurological sequelae, magnetic resonance imaging (MRI) repeatedly was performed. In initial examination, at week 7 after intoxication, MRI showed bilateral abnormalities of the amygdaloid nucleus, caudate nucleus and in globus pallidus at right. Haemorrhagic lesion of internal capsule was shown 10 days later. In the next examinations regression in basal ganglia was observed, but slight atrophy of brain was stated. Neuropsychological examinations performed simultaneously, allowed to evaluate the dynamics of central nervous system disfunction.

Adult↗
PubMed1997

[Acute poisoning with psychoactive substances among adult abusers of the Krakow population].

The aim of the study was to evaluate a frequency and the course of acute poisonings with psychoactive substances in abusers, considering the kind of toxic substance. 25% of all acute poisonings treated in the Department of Clinical Toxicology in the year 1996 that were acute poisonings with psychoactive substances among the abusers of Kraków adult population. Alcohol followed by narcotics and drugs and by organic solvents was predominant cause of acute poisonings in that group. Opiates derivatives as the so called kompot produced at home from poppy straw or juice of poppy head were the most common narcotics. Pure amphetamine was detected only in 5.3%, while as combination with other narcotics (opioids, THC, LSD) was detected in 31.2% of narcomans and drug abusers. The combination of opioids, barbiturates and benzodiazepines was predominant cause of acute intoxications with mixed substances abuse. That was followed by combination of opiates and barbiturates in the group of patient identified positively as two or more substance abuse in the body fluids. Tramal and benzodiazepines were the most detected drugs responsible for acute intoxications between drug abusers. Acute intoxicated ethanol abusers aged from 30-49 years and were the oldest group compared to narcotics and drug abusers (20-29 years) and to organic solvent dependent patient (15-19 years).

Adolescent↗
PubMed1997

[Analysis of observations in the admissions room of the Krakow Clinical Toxicology Department of substance dependent persons in relation to changes in central nervous system metabolism caused by substances of abuse].

Authors presented the course of clinical observation of 393 acutely intoxicated patients dependent on psychoactive substances (28%) or ethanol (72%) who were discharged from the hospital at their own request before diagnosis and treatment were completed. In the first stage of detoxification the different intensity symptoms of toxic coma (25% of patients), behavioral changes-agitation and aggression (16%) and also the disturbances in consciousness accompanied by tremor and vegetative storm (15%) were observed. Authors pointed out that among others the neurobiological changes in brain reward systems of patients who discontinued diagnosis and treatment could be endangering for both the patient and the doctor. They postulate that criteria of life threatening state should by more accurately defined and the methods of full security for patient and doctors should be worked out.

Adolescent↗
PubMed1997

[Use of naloxone in acute poisoning with opiates in substance dependent persons].

Acute poisonings with drugs of abuse in Poland in 1995 made up 3-4% of all cases of intoxications. In Kraków the most common cause of drug addiction resulting in life threatening states is the use and abuse of opiates derivatives produced by drug addicted people themselves. This domestic product, so called "kompot" or Polish heroin is produced from poppy straw or juice of poppy head (Papaver somniferum). "Kompot" shows the variable contents of heroin, 6-MAM, 3-MAM, morphine, acetylocodeine and codeine. Papaverine, thebaine and narcotine were also detected. The aim of the study was to investigate the frequency of application and the efficiency of naloxone in the treatment of acute poisonings with "kompot" in the subculture of Kraków drug abusers. 91 patients were treated in the Department of Toxicology in 1996 from the acute poisoning with "kompot". There were 24% of women and 76% of men. The age average was 25.2 years. In 61.5% of cases patients intake only "kompot", in 27.5% "kompot", benzodiazepines and barbiturates, in 6.6% "kompot" and amphetamine and only in 4.4% "kompot" with ethanol. In 10% of poisoned naloxone was applied only at the place of accident. In 58% only in the Department of Toxicology. 32% were treated with naloxone both at the place of accident and in the Department of Toxicology. At the place of accident in most cases the single dose was usually applied (mean dose 0.48 mg) and 76% of patients required the additional treatment with naloxone after the admission (mean dose 1.92 mg). Only 5.5% of acute intoxicated with kompot" drug abusers needed intensive care treatment. Complications in the form of vomiting and excitement were a rare case-5.5%.

Adolescent↗
PubMed1997

The results of the brain computer tomography and clinical picture in acute cholinesterase inhibitors poisoning.

The aim of this study was to evaluate a morphological and functional status of the CNS in acute cholinesterase inhibitors (ChI) poisonings using the brain computer tomography (CT) and complex psychiatric examination. Under examination there were 59 cholinesterase inhibitors orally poisoned patients, treated at the Department of Clinical Toxicology in years 1984-1997, aged from 14 to 68 (mean 34.7 +/- 12.8) years. The examined group comprised 9 women (15.3%) and 50 men (84.7%). Between the 3rd and 7th day of hospitalisation a complex psychiatric examination was performed. The CNS damage was diagnosed when the point score from complex psychiatric examination was minimum 5 points. CT was performed between the 3rd and 10th day after the intoxication. Incorrect CT scans were found in 78% of poisoned patients. The most common lesion was generalised cortex atrophy and subcortex atrophy of the brain (73.9%), followed by isolated cortex (17.4%) and subcortex atrophy with simultaneous areas of low density in the subcortical nuclei (8.7%). The frequency of incorrect CT scans was statistically higher (p < 0.01) in the group of organophosphorous compounds poisoned patients compared to those poisoned with carbamates. The complex psychiatric examination revealed in 24 patients (40.7%) the differently intensified alterations, but the point score was not higher than 4. Unquestionable damage of the CNS was recognised in 34 patients (57.6%) of the ChI poisoned patients. The frequency of CNS changes detected in complex psychiatric examination was statistically higher (p < 0.01) in the group of the severely poisoned patients. The significantly higher frequency of pathological changes revealed by the brain CT was found in the group of patients with higher than 5 point score obtained from the complex psychiatric evaluation compared to those with score lower than 5 (p < 0.001).

Acetylcholinesterase↗
PubMed1997

Pesticides poisonings in clinical and medicolegal aspect.

In the course of time, progress in knowledge, after many years of a widespread use of pesticides, it is necessary to evaluate negative results they cause. Poisonings with these xenobiotics have claimed new tasks and problems for toxicology. The present study comprises some complex problems of pesticides poisonings on the basis of examinations referring to non-fatal and fatal cases of poisonings in clinical and medicolegal aspects. They include cholinesterase inhibitor poisonings, dipyridil herbicides and chlorphenoxyacetate as well. On the basis of quantitative determinations of cholinesterase inhibitors relations between blood concentration and toxic effects were considered. Moreover, an elimination of inhibitors from blood in relation to the method of treatment and kind of pesticide was observed. In fatal cases of intoxication morphological changes in tissues, pesticides distribution and antemortem-postmortem relations were discussed. Toxicological findings in the cases examined constitute a data library for complex clinical and medicolegal purposes.

Humans↗
PubMed1996

The hippocampus as a cognitive graph.

A theory of cognitive mapping is developed that depends only on accepted properties of hippocampal function, namely, long-term potentiation, the place cell phenomenon, and the associative or recurrent connections made among CA3 pyramidal cells. It is proposed that the distance between the firing fields of connected pairs of CA3 place cells is encoded as synaptic resistance (reciprocal synaptic strength). The encoding occurs because pairs of cells with coincident or overlapping fields will tend to fire together in time, thereby causing a decrease in synaptic resistance via long-term potentiation; in contrast, cells with widely separated fields will tend never to fire together, causing no change or perhaps (via long-term depression) an increase in synaptic resistance. A network whose connection pattern mimics that of CA3 and whose connection weights are proportional to synaptic resistance can be formally treated as a weighted, directed graph. In such a graph, a "node" is assigned to each CA3 cell and two nodes are connected by a "directed edge" if and only if the two corresponding cells are connected by a synapse. Weighted, directed graphs can be searched for an optimal path between any pair of nodes with standard algorithms. Here, we are interested in finding the path along which the sum of the synaptic resistances from one cell to another is minimal. Since each cell is a place cell, such a path also corresponds to a path in two-dimensional space. Our basic finding is that minimizing the sum of the synaptic resistances along a path in neural space yields the shortest (optimal) path in unobstructed two-dimensional space, so long as the connectivity of the network is great enough. In addition to being able to find geodesics in unobstructed space, the same network enables solutions to the "detour" and "shortcut" problems, in which it is necessary to find an optimal path around a newly introduced barrier and to take a shorter path through a hole opened up in a preexisting barrier, respectively. We argue that the ability to solve such problems qualifies the proposed hippocampal object as a cognitive map. Graph theory thus provides a sort of existence proof demonstrating that the hippocampus contains the necessary information to function as a map, in the sense postulated by others (O'Keefe, J., and L. Nadel. 1978. The Hippocampus as a Cognitive Map. Clarendon Press, Oxford, UK). It is also possible that the cognitive mapping functions of the hippocampus are carried out by parallel graph searching algorithms implemented as neural processes. This possibility has the great attraction that the hippocampus could then operate in much the same way to find paths in general problem space; it would only be necessary for pyramidal cells to exhibit a strong nonpositional firing correlate.

Animals↗
PubMed1996

Acute ethanol poisonings during the New Year's Eve party "95/'96 in Kraków.

Distilled spirits are the major source of ethanol consumption in Poland. Such concentrated alcohol is drunk quickly, especially in teenager groups who consider consumption of 250 or 500 ml of vodka during one hour or one hour and half as quite normal. For two years the New Years Eve party has been celebrated in the Main Market Square in Kraków. In 1995 unfavourable weather conditions had been observed for at least 14 days before the New Year's Eve night. During that night only 15 people-participants of the party were admitted to the Department of Toxicology. The aim of this study is to present the cases of poisoned people with ethanol during the last night of the year 1995. All the patients were young (10 poisoned patients were below 17 years of age), considerably low body temperature, and relatively low coma grade. 80% of the patients were admitted between 0:00 and 5:00 a.m. after 200 minutes since the moment they started to drink alcohol. Blood ethanol concentration ranged from 1.2 to 4.23 g/L and serum osmolality from 338 to 440 mOsm/kg H2O. Both ethanol concentration and serum osmolality progressively rose reaching the highest values in the group of patient with III coma degree (p < 0.001). All the cases of acute ethanol poisoning presented in the study had a good outcome, as patient were admitted at the Clinic in relatively short time after symptoms of poisoning have occurred.

Adolescent↗
PubMed1996

The frequency of toxic methemoglobinemias in people living in the vicinity of refuse dumps in Barycz.

In the paper a thorough study of the influence of the methemoglobin levels and the occurrence of certain syndromes of clinical symptoms was made in the inhabitants living in the immediate vicinity of the large refuse dumps. During a 2.5-day clinical hospitalization the following examinations were done: general medical, specialistic and neuropsychological examinations, biochemical-analytical examination, EKG, chest X-ray, USG of the abdominal cave, spirometric tests, toxicological investigation of body fluids: carboxyhemoglobin, methemoglobin, lactates. The air pollution was measured and included: continuous measurement of the suspended particulate matter, carbon monoxide, sulfur dioxide, nitrogen oxide, nitrogen dioxide and the sum of nitrogen oxides. The evaluation of the refuse dumps gas showed that its main compounds were: carbon dioxide, methane in the amount of a few volume percent. Other pollutants were: carbon monoxide, hydrogen sulfide, methane homologues and aromatic hydrocarbons. The results of biochemical investigations were within normal limit. The elevated methemoglobin levels were found in 8 patients. The increased values of blood lactate concentration were found in 14 people and in 8 people the elevation of carboxyhemoglobin level was noted. The results of toxicological investigation do not unequivocally indicate the occurrence of toxic methemoglobinemia. However, the elevated levels of methemoglobin and lactates indicate a slight degree of oxygen deficiency in the body. In the examined people typical symptoms of methemoglobinemia were not observed, the only symptoms which may indicate their impact on the central nervous system were frequent headaches and neurovegetative disorders.

Adolescent↗
PubMed1996

Ethylene glycol acute poisoning treatment results in Kraków in the years 1990-1994.

An analysis of ethylene glycol acute intoxication treatment results was performed in a group of 36 patients hospitalized within a five year period. Mean serum and urine glycol concentrations in the analyzed population ranged from 0-851 mg/dl (mean = 130 mg/dl) and from 12.4 to 930.0 mg/dl (mean 333 mg/dl), respectively. At the time of admission to the clinic 15 of 36 patients were deeply unconscious and mean acid-base balance values were as follows: pH 6.99, pCO2 16.7 mmHg, pO2 140.1 mmHg, HCO3 6.36 mmol/l, BE -29.6 mmol/l. Because of respiratory failure 21/36 patients (58.3%) required controlled ventilation and 24/36 (66.7%) underwent dialysis. Sixteen patients (44.4%) developed acute renal failure. Mean hospitalization period was 16 days (1-53). Eighteen patients (50%) died. The direct death mechanism in 15 patients (83.3%) was asystolia and in the remaining individuals other circulatory disturbances. The main reasons of high mortality rate were multiple organ damages secondary to severe metabolic acidosis.

Acid-Base Imbalance↗