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Cerebral palsy is a wide group of diseases whose common feature are motor disorders. Patients affected by this condition show abnormalities of movement and posture. Various possible causes of damage were identified. Hypoxia, ischemia, infection, injury and congenital defects are one of the conditions that increase the risk of the disease. The first signs of cerebral palsy noted by parents are: incorrect head and torso stabilization, inability to sit and walk at the right age. There are currently no treatments available that would indicate good efficacy. . In recent years, stem cell therapies have enjoyed considerable interest. The encouraging results of many preclinical studies have indicated that stem cell therapy may have benefits in neonatal diseases. Despite many encouraging reports, data on the effectiveness of stem cell therapy in cerebral palsy are still insufficient. Scientists should continue to research the success of the therapy.

Introduction and purpose: Designer drugs also known as legal highs, research chemicals or herbal highs become more and more popular not only in Poland but also in other countries around the world. That might have many reasons but the most crucial is their easy availability and rather cheap price in comparison to other psychoactive substances. Material and methods: We analyzed the data of patients hospitalized in years 2013-2018 in the Toxicology Department in Lublin and evaluated patients hospitalized due to psychoactive substance poisoningT40 according to ICD10). Moreover the review of available scientific articles was done. Results: After analysis the data of patients hospitalized in years 2013-2018 we can observe increasing tendency of poisonings. The growing number of designer drug poisonings may be the result of many factors - the phenomenon of these substances is based not only on a wide range of products, but also on various advertising strategies and patterns of use. Conclusions: There can occur big diagnostic difficulties due to unpredictability of the course of poisoning and unpredictability of composition. Therefore it is very important to react quickly and choose the right treatment. Many of these poisonings are really severe and often cause death. It is worth saying that side effects occur more often in combined preparations. It is also very important to educate young people and warn against using NPS, which are particularly dangerous and risky for human organism.

Poland is among the infamous leaders among countries when it comes to the percentage of suicide attempts among young people. Methadone is a long-acting opioid agonist, which is mainly used as substitution treatment for heroin and morphine addiction. There is a typical triad for methadone overdose consisting of respiratory failure, myopic pupils and central nervous system depression. It may also lead to QT prolongation with following torsade de pointes. We present two teenager patients, who were poisoned with methadone. They were both under the influence of their boyfriend who was drug addicted. What is more, the girls both were in toxic relationship with the same man, who had similar influence on them. First patient was 18 years old. She was admitted to Department of Toxicology and Cardiology because of intravenous methadone overdose. The treatment used improved the general condition. No abnormalities were seen in the clinical examination. Teenager was examined by psychiatrist and psychologist. Second patient, 16 years old, was hospitalized twice. Teenager admitted that she got methadone from her boyfriend who is being treated for drug addiction. At the time of admission, the patient was emotionally disturbed, tearful, and periodically aroused. After two days of hospitalization girl was discharged home under mother’s protection. Three months later, 16 years old patient was admitted to the hospital again, because of intoxication with psychoactive substances and self-injuries. After three days of hospitalization, she was transferred to psychiatric hospital for further therapy. We can indicate methadone use not only as methadone’s level in urine, but also as EDDP, methadone’s metabolite concentration in urine. Every person with symptoms of behavioural disorder should be as fast as possible be examined by psychiatrist and psychologist, to avoid suicide attempts.

Introduction Despite developing strategies for treatment of people with schizophrenia, earlier mortality rate is still observed in this group of patients. One of the major causes remains suicides due to drug overdose. Main approach to the treatment of schizophrenia is pharmacotherapy that is based on antipsychotics. Yet, in order to sustain patients well being, medicaments from other groups may be introduced. Pharmacological treatment should be accompanied by psychotherapy to prevent suicidal attempts. Case report A 28 years old woman diagnosed with paranoid schizophrenia was brought by the ambulance and admitted to the Clinical Toxicology Department due to deliberate drug overdose. Her history indicated previous suicidal attempt. A patient took all her psychiatric medications that included 240 tablets of quetiapine (Ketrel a 200 mg), 100 tablets of zuclopenthixol (Clopixol a 25 mg), 100 tables of chlorprotixen, several tablets of escitalopram (Aciprex) and 12 tablets of bisoprolol (Bibloc a 5 mg) - in summary around 470 tablets. This suicidal attempt was probably the cause of abrupt drugs withdrawal after discharge from recent hospitalization in psychiatric department. Complications involved allo- and autodisorientation, enhancement of imperative auditory hallucinations and psychotic symptoms, respiratory failure and aspiration pneumonia. After admission, intensive symptomatic treatment was introduced in order to sustain living functions of the patients. Due to respiratory failure, she was in need of external mechanical ventilation. The end of hospitalization was followed by implementation of new drug (perazine) and transportation to Neuropsychiatric hospital for further diagnosis and treatment. Conclusion Process of pharmacotherapy in case of patients with schizophrenia should be continuously and precisely monitored by psychiatrists. Such control would minimize the chance of suicidal attempt. What is more, patient should not limit the therapy to drugs and psychiatric appointments, but also should attend to community health services.

Introduction Moya-Moya disease is a rare disease of unknown etiology that causes pathological occlusion changes in the large intracranial arteries - the internal carotid artery and the proximal parts of the anterior and middle cerebral arteries. The disease occurs most often among young Asian women, and its most intensive development falls on the first decade of life. In most cases, Moya-Moya occurs in the form of transient ischemic attacks, strokes or cerebral hemorrhages. Case report A 20-year-old woman was admitted to the Neurosurgery Clinic for the surgical treatment of Moya-Moya disease. Patient with paroxysmal paresis of left and right limbs several times since 2016. In CT, MRI and angio-MRI, as well as DSA, critical narrowing of the internal carotid arteries, obstruction of the anterior and central lights of the cerebral arteries, with small vessels around the central arteries and their branches marked - bilaterally, but mainly on the right. The changes create an image resembling "clouds of smoke" that is characteristic of Moya-Moya's disease. The patient was qualified for surgical treatment - revascularization of the cerebral cortex with the use of periosteal strips by multi-hole trepanation in the right fronto-temporo-parietal region. Periosteal stripes were introduced into the subarachnoid space to reproduce vessels of the cerebral cortex. Conclusion Because of the rarity of Moya Moya disease, it is very important to be alert vigilantly to avoid complications such as tetraparesis or mental retardation. Japanese surgery allows revascularization of the cerebral cortex without the need for an arterial bypass. The presented surgical method ensures good treatment effects and is preferred in young people due to the safety of the technique used. Keywords: Moya Moya disease, neurosurgery, hemorrhages

Pompe disease is estimated to happen in 1 out of 40 000 borns. It is rare metabolic disease connected to autosomal recessive genetic mutation. Disease is characterised by deficit of α-glucosidase (GAA) which is lysosomal glycogen hydrolizing enzyme acid. Decreased activity of enzyme leads to glycogen storage in lysosomes which appears as disfunction of tissues, especially cardiac muscle and skeletal muscles. In Poland, we have two common and very simple methods to diagnose Pompe disease. First test is dried blood spot (DBS), second is full peripheral blood test. Currently, in Poland, drug containing alglucosidase alpha is refunded. Drug is available as powder for infusion. Periodic assessment of therapy effectiveness is performed at least every 6 months based on rating the patient's clinical condition and assessment of the effectiveness of the therapy used.

Introduction: Deep vein thrombosis (DVT) is a condition in which a blood clot forms in one of the body's deep veins, most commonly of the leg or pelvis. Before the fourth decade of life risk of DVT is low (about 1 per 10000). After the age of 45, it rises and approaches about 5 per 1000 by the age of 80. Noteworthy is the fact, that patients with a positive family history have a higher risk of DVT at a young age. Essential risk factors for developing DVT are genetic conditions or acquired thrombophilia and positive family history, but the lack of family predisposition cannot rule out the occurrence of DVT. Standard treatment method of DVT involves intravenous anticoagulation with the use of low molecular weight heparin and compression therapy. Apart from the above-mentioned methods, we can distinguish intermittent pneumatic compression, surgical embolectomy, pharmacomechanical thrombectomy, and venous stenting. Case Report: We present a case report of 19 - year old patient who was first admitted to hospital in April 2017 urgently with symptoms of pulmonary embolism which was confirmed in angio-CT. Moreover, in the Doppler ultrasound, left common iliac vein (LCIV), left external iliac vein (LEIV) and left femoral vein (LFV) thrombosis was diagnosed. During the hospitalization, genetic tests, antibody levels, and antithrombin levels were performed for thrombophilia and systemic diseases conducive to thrombosis. In October 2017 the angio-MR of the pelvis confirmed visible pressure on the LCIV, caused by the common iliac artery, which corresponds to the May-Turner syndrome. In March 2018 he was admitted to the clinic with DVT symptoms of the left lower limb such as swelling, pain, and redness. The patient underwent venous angioplasty and stent implantation for LCIV. The patient was discharged from hospital with recommendations such as compression therapy, Doppler ultrasonography and monitoring of INR. Discussion: Venous thrombosis is a multicausal disease: more than one risk factor needs to be present before thrombosis occurs. Choice of DVT treatment method is aimed at improving the quality of life of patients depending on clinical symptoms. venous stenting for an iliofemoral occlusive disease is a safe and effective method of treatment. It can be done with excellent patency rates expected in cases of idiopathic occlusion and May-Thurner syndrome. On this basis, the legitimacy of using venous stent implantation as an effective method of treatment of recurrent DVT episodes can be confirmed, which has been used in the described case.

Introduction Suicidal risk caused by drug overdose is a considerable factor influencing earlier mortality among people with schizophrenia. An adjustment of effective pharmacological treatment is essential to sustain the stability of the patient. Commonly, the treatment divides to two groups: first generation antipsychotics (FGA) and second-generation antipsychotics (SGA). Yet, due to significant risk of depression and possible side effects of the drugs, other medicaments should also be introduced. Case report A 38 years old woman that was repeatedly hospitalized at the local ward, brought by ambulance and admitted to the Clinical Toxicology Department. She was admitted to the department for 20th time in period between April 2013 and May 2019 due to deliberate drug overdoses. During last hospitalization laboratory tests indicated presence of valproic acid (121,41 μg/ml). Moreover, psychiatric consultation revealed that although she was balanced state, she was not critical about her behavior. Patient was diagnosed with schizophrenia and mild intellectual disability. Each time, the intoxication was followed by medications from group of antipsychotics and tranquilizers used in treatment of the illness. Additionally, she confirmed that some of intoxications had suicidal attempt. 60% of hospitalizations of the patient were followed by stay in Neuropsychiatric hospital for further observation and treatment. Conclusion The administration of proper dosage of antipsychotics should be precisely controlled by the psychiatrist that takes care of the patient. For patients with greater suicidal risk, SGA are more recommended than FGA. Moreover, drugs from other groups such as antidepressants should also be introduced. Undoubtedly, efficient pharmacological treatment should be supported by psychotherapy of the patient.

In Poland in 2016, there were almost 10,000 suicide attempts, in which about 55% ended up with death. Suicidal attempts are more often taken by women, but they are more effective in the case of men. Most of these people are afflicted with mental illness such as depression. A 49 year old man was admitted to Cardiology and Toxicology Department, because of poisoning with antipsychotic drugs and ethanol. It was his second suicide attempt. The day he was admitted to the hospital he was in serious condition. Patient was monitored, symptomatic treatment and pharmacotherapy were initiated. The patient required intubation and the use of respiratory therapy because of breathing problems. In the clinical study and imaging examinations massive pneumonia, was confirmed. His pharmacotherapy was modified and the antibiotics were given because of inflammation of a lungs. For patients poisoned by various substances, respiratory failure often has a complex medium. It may result from the depression itself of the xenobiotics on the respiratory system, the influence of the indirect mechanism of breathing or the result of aspiration and development of pneumonia. In therapy the most important is the monitoring of the patient's condition, electrolyte imbalance and symptomatic treatment. In a few cases and only for some drugs, we can use a specific antidote.

Breast cancer is the most frequently occurring malignant neoplasm among women. Statistically, it constitutes 22,8% of all malignant neoplasms among females. Despite the fact that the causes of the disease remain unknown, a few risk factors are contributing to its development. Age, family history, type of lifestyle, hormones and genetic background have a significant association with occurrence of breast cancer. Due to the fact that time in which female sex hormones affect mammary gland is one of the most important risk factors of breast cancer development, more researchers focused on the use of drugs such as selective estrogen receptor modulators (SERMs) in the disease prevention. Tamoxifen has antiestrogenic effect. That results in the inhibition of both- growth factors release and synthesis by the tumour. Moreover, this drug works as agonist, replacing oestrogen to many tissues, such as the ones in liver, bone, breast and uterus. In the literature there are many reports about the effectiveness of tamoxifen in the prevention of breast cancer. The drug, in addition to using it as adjuvant therapy for breast cancer, can be used as a prophylactic of the disease. Side effects of the drug are rare, but they can not be completely excluded. Breast cancer, which is currently the most common tumour in the globe, is a serious worldwide public health quandary. Tamoxifen is considered to be a pioneering drug as it is used in combined breast cancer therapy and also in chemoprophylaxis ,but every case of using the medicine should be considered individually to assess benefit-risk ratio.

Introduction: Internal carotid artery (ICA) stenosis in a majority is caused by atherosclerotic plaque. Symptoms of ICA stenosis manifest most likely a transient ischemic attack (TIA). The dynamics of ICA stenosis progression is unpredictable, the disease may progress quickly or slowly or remain stable for many years. The method of treatment implemented also depends on it. The task of pharmacological treatment is to reduce the progression of the disease and protect against the onset of stroke. Among the invasive methods of treating ICA stenosis, the standard procedure is endarterectomy of a carotid artery (CEA), i.e. surgical removal of atherosclerotic plaque. Another method of treatment is endovascular carotid artery stenting (CAS). CAS should be considered especially in the case of re-operated patients, also after radiotherapy and tracheostomy. CAS is a less invasive procedure, it avoids complications typical for CEA such as cranial nerve palsy or complications at the site of the wound. On the other hand, the risk of postoperative ischemic stroke is greater in the case of CAS. In recent years, the improved CAS method seems to be the implantation of dual-layered mesh-covered carotid stent systems (DLS). Case report: We present the case of a 69 old man, long-term smoker, with hypertension and coronary heart disease. In 2001 diagnosed with larynx cancer and underwent surgical laryngectomy and radiotherapy. He was admitted in scheduled mode due to symptomatic carotid artery stenosis. In USG examination there was visible stenosis of the right internal carotid artery (80%) caused by an unstable atherosclerotic plaque with irregular structure and thrombotic clots. Due to the obvious difficulties of performing endarterectomy following radiotherapy in the neck area and laryngectomy, the endovascular method has been considered. In spite of the unstable plaque, which is a contraindication to perform the endovascular procedures CAS has been decided to perform. The patient underwent implantation of a dual-layered carotid stent in the combination with proximal balloon occlusion protection with a MoMa device. After procedure arteriography confirmed the optimization of the carotid artery flow and the correct position of the stent. The treatment was carried out without complications. After a few days of hospitalization, the patient was discharged home. Discussion: The method of treatment of internal carotid artery stenosis is selected taking into consideration morphology and localization of atherosclerotic plaque, anatomical conditions and the local condition of the surgical area as well as the general condition of the patient and coexisting diseases. On the one hand, the patient underwent cervical radiotherapy and laryngectomy which are contraindications for CEA. On the other hand, an atherosclerotic plaque was unstable with the features of stratification which is a contraindication to the performance of CAS. In the described case it was decided to make implantation of dual-layered carotid stent system (DLS) connected with proximal balloon occlusion protection with a MoMa device allowed to reduce the risk of embolization.

Backgrounds: Ethylene glycol poisoning is one of the heaviest poisonings in the toxicological practice of. Ethylene glycol is quickly absorbed from the digestive tract. Its toxicity is the result of combining few different mechanisms. Metabolites of decomposition, especially glycolic acid, are responsible for appearance of metabolic acidosis. Precipitated crystals of calcium oxalate additionally impair the function of organs such as kidneys, central nervous system (CNS) and circulatory system. Worldwide, from 2013 to 2018 about 30% of ethylene glycol poisoning cases end in death. Case report: We present the case of 56 years old woman, who was admitted to Toxicology Department because of ethylene glycol poisoning. We could observe presence of metabolic acidosis, respiratory insufficiency and organ damage. The patient has been treated pharmacologically and has been given specific antidote. Due to the ethylene glycol intoxication, metabolic acidosis and increasing parameters of kidney failure the patient also underwent hemodialysis. Conclusions: In pathogenesis of ethylene glycol poisoning toxic metabolits are crucial. The diagnosis of ethylene glycol is often a very hard task. In the clinical aspect it is based on the interview, a set of syndromes and biochemical tests and targeted toxicological tests. This kind of poisoning occur the most often among patients addicted to alcohol. It may lead to multi- organ damage or even death. It is very important to react quickly and implement pharmacotherapy and hemodialysis. The other essential aspect is to improve the level of knowledge of students and doctors about symptoms, diagnostics and proper proceeding with a patient poisoned with ethylene glycol. According to statistics and knowing how often the alcohol poisoning happens it is necessary to have knowledge in this field, be fluent in management and choosing methods of treatment in such cases.