Acute oral suicidal intoxication with Captan--a case report.
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Administration, Oral↗
Biomedical subjects
Zygmunt Chodorowski
Publications and source records attributed to Zygmunt Chodorowski.
[Lipoproteins HDL and coronary artery disease: a molecular mechanism of fibrate].
The importance of dyslipidemia in the development of cardiovascular disease is now recognized as a central factor of equal, if not greater significance than any other risk factor. Although correction of high level of low-density lipoproteins (LDL) has been regarded now as the main goal of therapy, it has now been reaffirmed that the contribution of low level of high-density lipoproteins (HDL) to the risk of ischaemic heart disease should also be considered. In the therapy of dislipidemias with hipertriglyceridemia and decreased level of HDL lipoprotein fibrates play an especially important role. In the article the molecular mechanism of fibrates action is presented.
Bezafibrate↗
[Suicidal poisoning with antihypertensive drugs].
In the period from 1990 to 2002, 201 patients with suicidal antihypertensive drugs poisoning were treated, including 138 women and 63 men from 15 to 84 (mean 36) years old. The main causes of suicides were various kinds of depression (63%) as well as psychopathy and/or sociopathy (16%) and schizophrenia (10%). Twenty eight patients attempted repeatedly to commit suicide. Thirty six persons were poisoned by only antihypertensive drugs, in 165 remaining cases intoxications were mixed including antihypertensive and other different medications. beta-blockers (38.3%), calcium channel blockers (34.8%), angiotensin converting enzyme inhibitors (24.3%) and diuretics (2.5%) were used in suicidal attempts. There were no suicidal poisonings with angiotensin II AT1 receptor antagonists, alpha 1-blockers and imidazole receptor agonists. In the examined group three patients died of cardiogenic shock, electromechanical dissociation and secondary acute respiratory failure resistant to therapy. The drugs used in these cases were propranolol, amlodipine, theophylline, captopril, doxepine, propafenone, furosemide, methimazole and alcohol. Mortality rate in antihypertensive drug poisonings was 1.5%.
Adolescent↗
[Longevity of physicians and medical scientists born from 1880 to 1904].
Analysis of biographies of 319 physicians (302 men and 17 women) born from 1880 to 1904, who died from natural causes, was carried out on the basis of annals of medical universities in Poland. Due to small number of women they were excluded from further analysis. There were no statistically significant differences in duration of life between medical scientists- professors, Ph.D. (n = 212, mean = 73.9 +/- 10 yrs) and physicians with the doctor's degree or without any scientific degrees (n = 90, mean = 72.6 +/- 11.4) and among medical scientists working in different fields--basic research (n = 42, mean = 75.1 +/- 9.7), non-invasive disciplines (n = 64, mean = 72.0 +/- 9.9), surgical disciplines (n = 89, mean = 74.4 +/- 11.0), disciplines with limited contact with patients (n = 17, mean = 75.8 +/- 9.0). Average life expectancy at the age of sixty in the whole examined group (16.1 +/- 8.6 yrs) was not statistically different from the general population of men born in the same period (15.1 yrs).
Female↗
[Neuroleptic malignant syndrome].
Neuroleptic malignant syndrome (NMS) is the most dangerous side effect of phenothiazines therapy. In the period of time from 1995 to 2002 in the Intensive Toxicological Unit there were five patients, 3 men and 2 women, aged from 25 to 62 (average 44.2) years-old, admitted from the regional inpatients psychiatric units with the diagnosis of pneumonia and/or sepsis. The patients about 48-72 hours before admittance were given some phenotiazine derivatives (promazine, perphenazine, clozapine, pipamperon) and/or buthyrophenone (haloperidol) because of psychotic state. Altered consciousness, muscle rigidity, hyperpyrexia (39.0-41.0 degrees C), sweating, tachycardia (120-150/min.), tachypnoea (respiratory rate more than 25/min.) and high level of creatine kinase activity (23,751-112,288 U/l) dominated. Only one patient had clinical picture of pneumonia. Because of the rapid development of acute respiratory failure, respirathorotherapy was initiated and continued for 8 and 10 days in two patients respectively. Transient thrombocytopenia (26,000/microliter) in one subject was observed. The neuroleptic drug was withdrawn and intensive supportive care with administration of bromocriptine (15-20 mg/24 h) was provided. None one of the doctors told the patients about the possibility of NMS during phenothiazines therapy.
Adult↗
[Suicidal salicylate intoxications and unintentional percutaneous poisoning with salicylic ointment].
Suicidal salicylate poisonings are presented in 49 patients, 33 women and 16 men, aged from 18 to 71 (mean 37) years. Mixed poisonings with multiple agents were four times more frequent, had more severe clinical course and demanded longer hospitalisation than acute intoxications with salicylates alone. Four patient were over 65 years old (8.2%). Difficult economic situation of geriatric population in Poland had no effect on frequency of suicidal attempts in the studied cohort. There were no fatalities in the studied group. There were two unintentional systemic poisonings due to topical administration of the 10% salicylic acid ointment for wide spread skin lesions (more than 80% of body surface) in two patients with exudative psoriasis.
Administration, Cutaneous↗
[Non-invasive positive pressure respiration in acute respiratory failure caused by suicidal oral intoxication with morphine sulphate].
In this article we described a 15-year-old female who was admitted to the Clinic of Toxicology because of suicidal, oral intoxication with morphine sulphate in the total dosage of 360 mg. In the Clinic the patient was in I degree degree of Matthew coma scale, with the heart rate about 90/min., blood pressure 105-100/70-60 mmHg, breath rate about 7/min. The arterial blood gas analysis showed acute respiratory failure (pCO2 64.1 mmHg, pO2 54.9 mmHg and SO2 88%) in spite of constant and intravenous Naloxone infusion. The mother of the patient, who was a nurse, had not agreed to endotracheal intubation and invasive method of respiration. Because of that reason the non invasive positive pressure ventilation with the BiPAP Synchrony apparatus were used with IPAP 14 cm H2O, EPAP 5 cm H2O, breath rate 12/min, time of inspiration 2.0 sek., time of inspiration grow 600 msek. After 15 minutes of respiration pCO2 decreased up to 40 mmHg, pO2 increased up to 73.3 mmHg and the oxygen saturation of arterial blood was 95.7-98.6%. Respiratory failure was observed every time when apparatus was withdrawn. After 24 hours of ventilation by BiPAP Synchrony apparatus the full stabilization of respiratory tract was achieved.
Acute Disease↗
Acute poisoning with Tricholoma equestre of five-year old child.
This report presents the first case in pediatric literature of the acute intoxication of a five-year old male child who ate 300-400 grams of Tricholoma equestre daily for four consecutive days before the onset of poisoning. The symptoms included acute respiratory failure with the need of respiratorotherapy, muscle weakness concerning especially the pelvic girdle and the urinary bladder. The boy could not sit or stand up without help and the bladder had to be catheterised, several times daily, to avoid urine retention. The biochemical tests showed only minor muscle injury with maximal activity of creatine kinase 306 U/L, aspartate aminotransferase 39 U/L, alanine aminotransferase 56 U/L. No other causes responsible for the signs mentioned above such as trauma, viral, bacterial, neurologic and immune diseases or exposure to medications were found. All the symptoms and biochemical abnormalities disappeared within 12 days of hospitalisation. We believe that the clinical picture of poisoning with this wild mushroom might be different in children and adults.
Acute Disease↗
[Renal replacement therapy in the elderly patients in the Gdansk Pomeranian region].
Aging of population is a common phenomenon all over the civilized world. It results in increasing number of aged patients with end-stage renal disease. We analysed patients over 65 years who have been qualified for renal replacement therapy (RRT) since 1997. From that time age was no longer barrier for RRT in Pomerania region. Number of aged patients starting RRT raised systematically and achieved 61 pts in 2000. It was 25% of all starting this therapy in our region. In this period we observed changes in the causes of primary renal diseases: diabetic nephropathy raised from 15 to 27.8%, but hypertensive nephropathy unexpectedly was stable at 5%. Most of elderly patients qualified for RRT lived in town--74.6%. It means that many of them living in rural areas did not have adequate nephrological care and probably some of them have not been qualified for RRT. Late referral in this group is still a great problem. Many patients have never been referred to nephrologist before starting RRT. In majority of those cases no definitive diagnosis of ESRD was established. At present we are aiming at international standards and patients are started on RRT with lower level of serum creatinine than earlier. Increasing number of patients with diabetic nephropathy and in advanced age will require great effort both from nephrological community and health care system.
Aged↗
[Some aspects of pharmacotherapy among the eldest living in veterans' homes].
We have described some aspects of pharmacotherapy among 89 residents of veterans homes, 20 men and 69 women, aged between 90 to 103 (average 92.3) years old. Half of the residents strictly complied with the doctor's instructions whereas 22% used to either discontinue taking the drugs or decrease the dosage according to their own will. Polypragmasia was not very common. About 21% patients used to take from 4 to 7 drugs whereas 9% from 8 to 10 medicines. Guiding instructions of International Medical Associations regarding pharmacotherapy were initiated on a very small scale for patients over 90 years of age. Due to that, the therapeutic procedures were highly incompatible with present standards.
Aged↗
[Psychological examinations of the personality of patients with cardiac syndrome X].
76 patients with chest pain including 27 men and 49 women from 25 to 75 (mean 49.96 +/- 11.36) years old, were examined by means of the psychological test. All the patients showed positive exercise test and no changes in coronary arteries. Psychological test was done by the use of personality--MMPI--2 (Minnesota Multiphasic Personality Inventory) test and depression was diagnosed by GDS (Geriatric Depression Scale) by J. Yesavage--15 questions version. The highest mean values in MMPI--2 were obtained in neurotic scales. It indicates that emotional disorders in these patients emerge as hypochondriacal and hysterical neurosis. In 37 patients (48.7%) neurotic scales showed typical "conversion valley" and these who show such a change in MMPI--2 talk mainly about somatic complains (not psychological) during long-term stress situation. In 25 (32.9%) patients single psychological symptoms of depression could be seen and depression episodes were diagnosed in 17 patients (22.4%).
Adult↗
[The other face of statins].
Clinical studies indicate that treatment with statins significantly reduces the incidence of myocardial infarction and death from cardiovascular diseases. Quite recently statins were found to exert a direct cardiovascular effect, which is independent on their well-known cholesterol lowering action. In this article current views on the role of statins in improvement of function of vascular endothelium are presented.
Anticholesteremic Agents↗
[Internet as a means of persuading a patient to commit a suicide].
In this article we have described 25 year-old female student of the University of Gdańsk, treated for eight years because of depression and for four years because of anorexia nervosa, who to commit suicide had taken 50 tablets of carbamazepine (Tegretol CR á 200 mg), 30 tablets of clonazepam (Clonazepamum á 0.5 mg) and 50 tablets of flupentixol (Fluanxol á 3.0 mg). In 1999 the patient got an internet (IRC) contact with a person introducing herself as a 26 year-old lonely student. After getting acquainted with the life history of the patient she had systematically encouraged the patient to commit suicide. Almost everyday she used to send the patient instructions regarding the best way to kill herself. On parent's request, after the patient regained consciousness in the Clinic, the case was sent to public prosecutor's office. It was found, that the person who urged the girl to commit suicide was a 33 year-old married woman, fascinated by psychology and parapsychology.
Adult↗
[Repeated metallic mercury intravenous injections for doping].
In this article we described a 24 year-old patient, suffering from nephropathy of unknown origin, who was admitted to the Clinic after having tried to commit suicide for the third time by overusing tricycle antidepressant drugs (TLPD) and ethanol. During toxicological tests the serum TLPD level was 548 micrograms/L and the serum ethanol level was 2.1 g/L. His chest X-ray showed the presence of several metal particles of approx. 1.5 mm in diameter disseminated in both lungs, which could have been particles of metallic mercury. When the state of coma was over the patient admitted that for the past three years he had many times injected intravenously a small amount of metallic mercury (about 0.5 ml/dose) to improve his strength, speed and physical fitness. Tested serum mercury level was 300 micrograms/L and urinary mercury excretion 500 micrograms/L/24 hours.
Adult↗
[Fatal intoxication with paramethoxyamphetamine].
From August to December of the year 2000 we ascertained 7 rapid deaths because of acute intoxication with tablets colloquially called Ufo. There were five men and two women aged from 20 to 29 (average 24) years. Analytic tests showed that one tablet of Ufo contains 40 mg of paramethoxyamphetamine, 1.0 mg of amphetamine, 0.05 mg of methamphetamine, 0.03 mg of 3-4-methylenedioxymethamphetamine. The levels of paramethoxyamphe-tamine in the blood of the deceased, determined by gas chromatography, were from 0.68 to 10.0 (approx. 3.2) mg/L and in the urine from 16 to 64 (approx. 35) mg/L. The press and television campaign caused elimination of fatal intoxications with parametoxy-amphetamine during the last 13 months.
Adult↗
[Cappuccino coffee treatment of xerostomia in patients taking tricyclic antidepressants: preliminary report].
10 patients underwent a trial treatment with Cappuccino coffee. All of them (8 university lecturers and 2 clerks) aged from 60 to 69 (average 63) years old, used tricyclic antidepressant because of insomnia as a monosymptomatic type of depression or insomnia as a dominant symptom in the course of depression. One, evening dose of doxepine was from 150 to 250 (average 225) mg, causing xerostomia next day usually between 9-15 o'clock. The five-minute--chewing of 15.0 g of Cappuccino coffee increased the amount of saliva, decreased xerostomia and improved the ability of speech. Beneficial effect of coffee lasted from 0.5 to 4 (average about 2) hours. To the best of our knowledge there are no publications dealing with the positive effect of coffee in xerostomia.
Aged↗
Acute poisoning with Tricholoma equestre.
Two cases, mother and her son, suffering from acute poisoning with Tricholoma equestre were described. They had eaten 100-300 grams of this wild mushroom during nine consecutive meals. About 48 hours after the last meal containing the mushroom they developed fatigue, muscle weakness and myalgia, loss of appetite, mild nausea, profuse sweating. Maximal serum creatine kinase activity was 18,150 U/L in the mother and 48,136 U/L in the son. Maximal serum levels of aspartate aminotransferase and alanine aminotransferase were 802 U/L and 446 U/L, respectively, in the mother and 2002 U/L and 454 U/L, respectively, in the son. All routine biochemical tests were within normal range. No other causes of rhabdomyolysis such as parasitic, viral, immune diseases, trauma or exposure to medications were found. All the above mentioned symptoms and biochemical abnormalities disappeared within 23 days of hospitalization. Our observation confirms the results of Bedry and co-workers that Tricholoma equestre contains a toxin, which can cause rhabdomyolysis.
Acute Disease↗
[The influence of media propagation of euthanasia on suicide attempts among terminally ill patients].
During consecutive two weeks of the year 2000 in the Clinic of Toxicology of Gdańsk Medical University we hospitalised because of suicide attempts three women suffering from cancer and one suffering from sclerosis multiplex. All of them as main cause for this desperate action mentioned the lack of sufficient pain control, but the direct inspiration was the local TV programme about euthanasia. According to the information in the TV programme the patients took orally morphine sulphate in the dosage from 300 to 1000 (615 approx.) mg. In all the four patients acute respiratory insufficiency occurred, one subject needed approximately 60 hours of respiratorotherapy. Psychiatric consultation revealed reactive depression syndrome in all the cases, requiring pharmacological treatment. After being discharged from the Clinic the patients were sent to Pain Control Dispensary.
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