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We undertook this study to evaluate the effects of needle acupuncture on cardiac autonomic nervous system (ANS) function in patients with minor depression or anxiety disorder. Patients (n = 36) were randomly distributed into a verum acupuncture (VA) group (needles were applied at classical acupuncture points, e. g. He7, Pe6, Du20, Bl62, Ex6) or a placebo (PL) group (needles were applied only epidermal at non-acupuncture points). Both groups underwent standardized measurements of the 5-minute resting heart rate variability (HRV), which were performed before the first and after the 9th acupuncture session of an acupuncture series, and also three times (before the start and 5, respectively, 15 minutes after needle application) during the third acupuncture session. Demographic data between the VA and PL group did not differ. Before the start of acupuncture there were also no significant differences in HRV data between these groups. Compared to PL the VA group showed a significant decrease of the mean resting heart rate both, 5 and 15 minutes after needle application, combined with a trend towards an increase of the high frequency (HF; 0.15 - 0.4 Hz) and a decrease of the low frequency (LF; 0.04 - 0.15 Hz) spectral power. The latter effects resulted in an overall significant decrease of the mean LF/HF ratio in VA compared to PL treated patients. This pattern of findings suggests that in patients with minor depression or anxiety only verum acupuncture 1.) leads to a relative increase of cardiovagal modulation of heart rate and 2.) facilitates the physiological regulatory ANS function in response to alterations of external or internal environment. Clinical implications of these findings are discussed.

The aim of the study was to evaluate myocardial perfusion in acute carbon monoxide poisoned patients using rest and stress Tc 99m-MIBI SPECT scintigraphy. There were 29 study patients (15 men and 14 women) aged from 14 to 46 years poisoned acutely with CO at home. Measurement of COHb, blood lactate level, duration of exposure and ECG examination were performed on admission to the Clinic. The enzymes activity (ALT, AST, CBK) were evaluated after 24 hours. The first rest Tc99m-MIBI SPECT was performed in all patients two to five days after intoxication. Fifteen of the patients underwent the control examination: stress and rest scintigraphy six months after CO exposure. Moving track exercise according to the Bruce protocol was used in each the patients. The control rest scintigraphy was performed 48 hours after exercise. Abnormal, differently intensified scans were noted in all the subjects: 5 patients had a I degree of pathological changes, 7 patients had II degree, 16--III degree and 1 patient had a IV degree of pathological changes. In 14 of the patients with pathological scintigraphic scans the normal EKG curves were noted. The mean COHb level was 35.0 +/- 7.22%, the blood lactate concentration was 4.4 +/- 3.7 mmol/L. The average duration of exposure was 108.4 +/- 163.9 min. Effort related ischemia was not noted in 10 of the patients who underwent control examination. An improvement in rest scintigraphic scans was stated in 12, and no changes were observed in 3 of the controlled patients. Deterioration was not found in any patient. No correlation between ECG results and scintigraphic image of myocardium was found. Tc 99m-MIBI SPECT scintigraphy is a more sensitive method than electrocardiography and measurement of enzymes activity for the evaluation of CO cardiotoxicity in acute poisoning. The method enables evaluation of the localization and disease extent.

That the problem of drug addiction is still growing up, so there is the necessity for widen of treatment panel for psychoactive substances abuse, especially for opiates. Because of the fact, that substituting treatment became to be popular in patients' opinion, more attention were paid on new medicine-buprenorphine. It is an agonist- antagonist of opiates' receptors. Buprenorphine has been successfully used in long-term treatment in United States and in Western Europe. Treatment with buprenorphine has been started in Poland in Toxicological Department in Kraków. This article shows outcomes of substituting treatment with buprenorphine in period from December 2000 to February 2001.

Methadone treatment programme for 50 opiate addicts has been conducted at the Department of Clinical Toxicology for a one year. The aim of the study was to evaluate the health state including psychological condition and also a social status of the opiate dependent patients after one year methadone maintenance medication. Also, considering the results of clinical examination, a trial of elaboration of system for dependence scoring was undertaken. An improvement of general health state of addicts was observed. No new cases of HIV positive patients were noted. An increase in number of addicts who start professional activity, and those who live in procreative families and even in formally confirmed marriage. A three pregnant women, and five who already gave birth to a child (one of them is completely drug free at present) were noted. A significant behavioural changes, reduced level of criminal activity and restored personal relationships with family were observed. A moderate psychopathological symptoms are still observed in patients with double diagnosis.

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

The blood clearance of Tc99m MIBI is rapid and biexponential, with an initial fast phase followed by a slow phase. The fundamental myocellular uptake mechanism involves passive distribution across plasma and mitochondrial membranes, and at equilibrium, sestamibi is sequestered within the mitochondria by the larger negative mitochondrial transmembrane potential. Reverse distribution into blood stream is stopped by the high membrane potential of the cardiac cells. Scintigraphic changes followed by the metabolic abnormalities in patients after acute carbon monoxide poisoning can be necrosis or only the transitory ischemia. It seems to detect accurately the extension of the early necrosis (unreversible) of the myocardium. Amiscan kit for the preparation of Tc99m-glucarate is being developed as a radiopharmaceutical diagnostic agent for the imaging of and diagnosis of acute myocardial necrosis. Cellular and subcellular uptake studies have shown that Tc99m-glucarate localizes in necrotic tissues binding primarily to the nucleoprotein sub-fractions and to a lesser extent to the DNA fractions. Glucarate is taken up rapidly by necrotic myocardium and cleared relatively rapidly from the circulation resulting in early, hight target-to-background ratios. In studies of Amiscan in patients with acute myocardial infarction, sensitivity was found to be 100% when Amiscan is administered within 9 hours of the onset of chest pain. In our preliminary study the scintigraphic scans using Tc99m-glucarate were performed in 10 patients after acute carbon monoxide poisoning. The study can confirm that some patients during acute CO poisoning have typical myocardial necrosis, but part of them have hibernating and/or stunned myocardium.

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

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

The aim of this study was to determine the concentration of zinc, copper and magnesium in the blood serum of drug addicts in order to ascertain whether drug abuse has an effect on the concentration of these metals. The study was carried out on a group of 33 addicts undergoing treatment at the Department of Clinical Toxicology, Collegium Medicum, Jagiellonian University in Kraków. The control group consisted of 22 young, healthy, drug free, male volunteers. Analyses were performed using flame atomic absorption spectrometry. The results demonstrate that zinc serum concentrations in the examined group of addicts before therapy (mean 0.82 mg/l) were reduced in relation to the control group (mean 1.12 mg/l), and was slightly enhanced after the detoxification process (mean 0.86 mg/l). The opposite effect was observed in the case copper serum concentration. The copper level in the group of addicts on admission to hospital (mean 1.35 mg/l) increased in relation to the control group (mean 1.11 mg/l) and was lower during hospitalisation (mean 1.18 mg/l). The concentration of magnesium in the serum of drug addicts did not change during therapy and was in the same range as in the control group (mean concentrations were 20.3 mg/l, 20.2 mg/l and 20.6 mg/l respectively).

Opioid drugs and alcohol, both central nervous system depressants, may also have a depressive action on the brain stem centre responsible for breathing control. Disorders of breathing regulation are reflected in respiratory efficiency. The aim of this study was to evaluate the regulation of breathing by measuring the respiratory pattern and occlusion pressure of abusers of opiates and alcohol. There were 180 persons under examination: 84 alcohol abusers (group I), 36 opiates abusers (group II) and 40 healthy persons (control group). Both groups of dependent persons were treated in the Detoxication Unit of the Department of Clinical Toxicology CMUJ. Respiratory regulation was evaluated "on line" by means of synchronous measurements of the respiratory pattern (according to Milic-Emili assumptions) and occlusion pressure P 0.1 (according to Whitlaw assumptions). The central respiratory drive (VT/Tin) and the timing component of the breathing cycle (Tin/Ttot) were simillar in both groups of abusers. In comparison to the control group, in the group of opiates abusers, values of VT/Tin were higher during examination performed after treatment, and values of Tin/Ttot were elevated (in group I--only before treatment; in group II--before and after treatment). Examination of respiratory pattern and occlusion pressure is based on recording spontaneous breathing, which this can be performed even in unconscious patients in very early stage of poisoning.

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.

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.

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.

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 (p0.01) 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 (p0.01) 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 (p0.001).

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).

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.

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.

Concentration of magnesium in hair was measured by atomic absorption spectrophotometry in 3 groups of persons aged 48 to 79. All the participants of the study lived at least 10 years and none of them worked in industry or commerce. Their work place was in the distance less than 10 kilometers from their dwellings. The first group comprised inhabitants of the protective zone surrounding the Steel-Mill Huta im. Sendzimira, southern Poland, regarded as one of the biggest source of air, water and soil pollution. The second group constituted inhabitants of down-town Kraków (some 15 km from the steel-mill). The third group were the inhabitants of Tokarnia village with favourable microclimate. Though the concentration of magnesium in hair was similar to the one reported by other authors, it was shown that the concentration of this cation in hair was the smallest in the inhabitants of down-town Kraków and the highest in Tokarnia. The differences were statistically significant. It is postulated that magnesium hair concentration may be an easier, cheaper and less invasive indicator of body magnesium depletion.

The concentration of fetal hemoglobin (HbF) in blood of 195 healthy men and 39 women was measured by alkali denaturation method of Singer et al. Arithmetic mean in the group of men was 0.325% whereas in women it was 0.399%. The difference between the means was statistically significant. Frequency histograms showed two unlike subpopulations with wider span of values in women, different standardised skewness and kurtosis. Kolmogorov-Smirnoff test revealed a significant abnormality of both distributions. The data presented may serve for the comparison of HbF values obtained in persons living and working in similar microclimatic conditions.

The aim of this study is to compare the frequency, kind and structure of acute poisonings of the Kraków residents in years 1983 and 1993. The group of 2132 people treated for acute poisonings in the year of 1983 consisted of 50.6% men and 49.4% women, in 1993 the group of 2311 patients consisted of 60.7% men and 39.3% women. The group of 154 poisoned who died at the place of accident in 1983 consisted of 89.6% men and 10.4% women, whereas in 1993 the group of 220 such cases included 83% men and 17% women. The overall coefficient of poisonings during the years compared was 36.2 for 1983 and 42.0 for 1993. The coefficient of poisonings in the years examined of 1983, 1993 were 39.4 and 50.4 for men, and respectively 33.4 and 28.0 for women. In 1983 the poisonings with drugs (40.6%) were most numerous, ethanol came second (25%). In 1993 the first place took ethanol (31.8%), the second drugs (31.3%). The number of poisonings with carbon monoxide increased from 9.87% in 1983 to 13.6% in 1993. The comparison of numbers concerning the mortality rate of the treated patients and of those who died at the place of accident prior to any treatment, shows a considerable growth in mortality rate in 1983 from 1.1% up to 7.8% and in 1993 from 0.8% to 9.4%. Such a significant growth in this mortality rate is influenced by poisoning with ethanol and carbon monoxide at the place of accident.

Fenitrothion has been reported as one of the organophosphates causing so called "intermediate syndrome"--clinical entity of still unclear reasons. That is why we decided to perform a retrospective examination of oral intoxication with this compound. Clinical course of 16 cases were analysed. Clinical state on admission, AChE activity and pesticide concentration in blood were considered. Gastric lavage, atropine and oximes were included in the treatment. 6 patients died in the period of 5 to 22 days (mean 11.8) from poison intake. All 6 revealed slight signs of poisoning at the time of admission (first 24th). AChE was moderately inhibited. Patients' clinical state was deteriorating and AChE activity was decreasing during next 48 h even though oximes therapy was applied. Intubation and mechanical ventilation was required. Fenitrothion concentration in blood varied from 470 to 8350 ng/ml (mean 2823 ng/ml). In 3 fatal cases toxicological examination of autopsy tissue was done. High fenitrothion concentration was found in adipose tissue and also in the brain. In the group of 10 recovered patients "intermediate syndrome" was not observed in 3 only. AChE activity returned to normal quickly. Fenitrothion concentration ranged from 96 to 360 ng/ml (mean 202 ng/ml). In the remaining 7 clinical state became worse during next 48-72 hours after temporary improvement. Respiratory failure and increasing AChE activity inhibition were major signs. Fenitrothion concentration varied from 180 to 3020 ng/ml (mean 1690 ng/ml). AChE inhibition persisted even for 30 days from poisoning.

A case of limbic encephalitis diagnosed in a 56-year-old man with small-cell lung cancer is reported. Death occurred after 6 1/2 months due to cardiorespiratory insufficiency. Psychopathology, course and diagnostic findings of the syndrome are described, and pathogenetic hypotheses are discussed.

In a 16.5-year follow-up study of the steel industry we investigated the relation of chronic occupational exposure to the changes of ventilatory efficiency and to the frequency of chronic bronchitis (Chronic Obstructive Pulmonary Disease--COPD) in a group of 65 men working in the harmful environment of a Coking Plant (CP). The reference group comprised 34 employees of Cold Rolling Mill (CRM) working in favorable hygienic conditions. The faster decline of VC and FEV1 were noted in the group of CP in comparison to the control group. Also the frequency of pathologic values of RT was significantly higher (por = 0.001) in the exposed group. The incidence of COPD increased more in the group of CP than in the group of rollers. No differences in the annual decline of FEV1 and VC between smokers and nonsmokers from CP were noted, while in the group of men working in favorable environmental conditions the differences between smoking categories were significant. It suggests that the impact of occupational exposure is so powerful that it can mask the unfavorable influence of cigarette smoking on the ventilatory function of men working in a Coking Plant.

It has been found out that 45% of the Toxicology Clinic patients hospitalized by their suicide attempt had previous suicide attempts. Calculations have shown that there were 76 previous suicide attempts in all and that 48 (63%) among these were not followed by any psychological and/or psychiatric help. The most frequent reason of this was keeping the attempt secret from further environment. Among the persons repeating suicide attempts affective illnesses, brain damage and personality disturbances were more often diagnosed; mental disturbances of their parents and/or disruption of their families in their childhood in the cases of these patients were also more frequent. Collapse or loss of significant interpersonal relations was a more frequent motive for trying to take one's life with persons repeating suicide attempts.

Acute poisoning by carbon monoxide (CO) in Kraków takes the third place after drug and alcohol poisoning. When natural gas came into use, the incidence of acute CO poisoning decreased profoundly. But mortality rate of this poisoning can still tell how severe it is. The authors presented the relation between the incidence rate, complications and mortality rate of CO poisoning and the source of this gas emission. 243 subjects were treated in the intensive Toxicological Care Unit from 1966 to 1985, and during the first 10 years lighting gas was the main cause of the poisoning but during the second the poisoning was mainly caused by CO produced by incomplete combustion of some components of natural gas. This 20-year period was characterized by routine treatment. The change of CO emission source introduced in 1976 had not radical statistical influence on the clinical picture, complications, mortality of CO poisoning.

36 patients of a dialysis-transplantation program with well functioning cadaver kidneys were investigated psychometrically for organic losses in intellectual function. 50% of the patients showed organicity an average of 16 months after transplantation. These organic deficits were found significantly more often when dialysis treatment had been complicated by marked medical problems. It is concluded that early transplantation of well dialyzed, medically fit patients will contribute to preventing persistent organic brain syndromes.