http://www.biomechanicsofinjury.com/casestudies/references/aircraftcrash01.pdf

Carbon monoxide intoxication : An updated review

Object Progressive intracranial hemorrhage after head injury is often observed on serial computerized tomography (CT) scans but its significance is uncertain In this study, patients in whom two CT scans were obtained within 24 hours of injury were analyzed to determine the incidence, risk factors, and clinical significance of progressive hemorrhagic injury (PHI) Methods The diagnosis of PHI was determined by comparing the first and second CT scans and was categorized as epidural hematoma (EDH), subdural hematoma (SDH), intraparenchymal contusion or hematoma (IPCH), or subarachnoid hemorrhage (SAH) Potential risk factors, the daily mean intracranial pressure (ICP), and cerebral perfusion pressure were analyzed In a cohort of 142 patients (mean age 34 ± 14 years; median Glasgow Coma Scale score of 8, range 3–15; male/female ratio 43:1), the mean time from injury to first CT scan was 2 ± 16 hours and between first and second CT scans was 69 ± 36 hours A PHI was found in 423% of patients overall a

Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury

Evaluation of antidotes for poisoning by organophosphorus pesticides

Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning.

Aims. Buprenorphine at high dosage became available in 1996 for substitution treatment in France. This drug is considered particulary safe and has become widely available in general medical practice. We investigated the possible implication of a buprenorphine-benzodiazepine association in six deaths of known abusers. Design. Full investigation of cause of death was conducted for six drug abusers. Setting. The deaths occurred in two regions of France (Auvergne and Lorraine). Assays were carried out by the Institut de Medecine Legale at Strasbourg, France, one of the few French laboratories equipped to assay buprenorphine. Measurement. First, the blood and urine underwent triple exhaustive screening. Secondly, buprenorphine and norbuprenorphine were analysed in all the autopsy samples by HPLC/MS. Findings. Benzodiazepine-buprenorphine associations were found in every case; no other substances that could account for the death were found. The tissue concentrations were markedly higher than the blood levels. Conclusion. If the number of deaths linked to such drug misuse proves high, it may be necessary to review how buprenorphine is dispensed.

Six deaths linked to concomitant use of buprenorphine and benzodiazepines

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 Krakow. 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).

[Concentration of zinc, copper and magnesium in the serum of drug addicts].

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.

Intermediate syndrome in acute fenitrothion poisoning.

H. fossilis (Bloch, 1794), commonly known as the stinging catfish, is the only species belonging to the family Heteropneustidae found in Asia. Stinging catfish have an elongated, subcylindrial body; just beyond the ventral fin bases, the body tapers off to the tail (Fig. 1). The head is depressed and bony plates cover the top and sides. The snout is depressed, and the nostrils are far apart, the slit-like anterior nostrils are positioned behind the nasal barbules. There are four pairs of rather long barbells, the maxillary pair extending as far as the ventral fins, and the two pairs of mandibular barbells and the nasal barbules reaching the end of the pectoral fins. The mouth is small and terminal. The eyes are relatively small, lateral in position, and with a free orbital rim (1). H. fossilis are facultative air-breathers that inhabit the swamps of southeast Asia and are quite common. It is dangerous due to the connection between the spines in the pectoral fin and the venom glands. In its natural environment, the fish can reach up to 70 cm in length; however, when bred in the aquarium it is significantly smaller. The males of this species have venom glands located near the spine of the pectoral and dorsal fins. Fishermen are afraid of this fish and if they catch it in their nets, they remove it with a piece of cut-off net, with great care. A 17-year-old man presented to the Department of General Surgery of the District Hospital in Limanowa with a slight injury to the fifth finger of his right hand. He was an aquarium fish breeder. While cleaning his fish tank, he was stung by a ray of the pectoral fin of the stinging catfish (length about 15 cm). The patient was admitted, due to his having fainted. He complained of numbness, dizziness, and quite intense pain at the site of the injury progressively extending into the surrounding areas. At the base of the finger there was a puncture wound about 1mm in diameter with small edema and erythema. On admission, his temperature was 37.2 C, with a heart rate of 96 and blood pressure of 110/ 60. Tests were made for the following: ESR, complete blood count, electrolytes, enzymes, and coagulation profile. All of them were normal. Incomplete right bundle branch block was noted on the ECG, but was not considered due to stinging catfish poisoning. The Poison Information Centre of the Clinic of Toxicology, the Jagiellonian University Medical College, Kraków, was consulted. The area of wound was infiltrated with 1% lidocaine and examined carefully. Pieces of foreign material were removed. The wound was thoroughly irrigated and cleansed with antiseptic solution and left open. A plain radiographic study of the injured area excluded retained barbs or other foreign material. The affected hand was immersed in hot water (45 C) for approximately 45 minutes for inactivated venom in the wound. The patient received a prophylactic short course of oral antibiotic therapy with Trimethoprim-sulfamethoxazole. After 24 hours of observation, the patient was discharged from the hospital at his own request under the care of his father. As injuries inflicted by fish may result in delayed presentation of infection it was suggested that the patient be admitted for observation. Over the next month, the wound healed slowly by second intention. At 2 months the wound appeared to be completely healed without any complication. The hand had healed completely without any deficits in motor and sensory function. In the Clinic of Toxicology of the Jagiellonian University Medical College, various patients are evaluated and hospitalized due to bites inflicted by animals occurring naturally in Poland, as well as those bred in home terrariums (2). The management, in the case of the poisoning with the stinging catfish venom, is predominantly symptomatic (3,4). The treatment is predominantly symptomatic. In some fish, there are masses of one-cell glands, mainly serous, in the proximity of the spines. In others, those one-cell glands may be grouped in larger aggregates of cells called venom glands, that may form organs resembling multicellular glands of terrestrial animals. They are usually located around the spines or hard rays of the fins. Even if covered with a connective tissue sheath, the aggregates of the venom cells do not have any common outlet; they are not, therefore, proper multicellular glands. The venom glands of the catfish are covered with a thin sheath and they release their contents when the fin ray is pressed. Spines are derived from fin rays (3). When the spine penetrates the body of its prey, it presses its base against the cells, squashes them, and squeezes the venomous contents into the wound. The venom appears to Address correspondence to Leszek Satora, Ph.D., Poison Information Center, Collegium Medicum, Jagiellonian University, Os. Zlotej Jesieni 1, Kraków 31826, Poland. E-mail: satora@wp.pl

Stinging catfish poisoning.

Although it is known that drug addicts are a high-risk group for disruption of many homeostatic processes, little is know about changes in serum trace elements concentrations after taking the psychoactive substances. The aim of the study was to check the influence of the taking homemade heroin on serum level of copper. Blood samples were taken from 30 opiate addicts, and copper concentrations were measured by the means of atomic absorption spectrophotometry. The result of the study show that in the examined group, copper serum concentrations (1.35 mg/L) upon admission to the clinic were higher than in the control group (1.11 mg/L) but decreased during hospitalization (1.18 mg/L). There was no correlation between duration of stay at the hospital and changes in serum copper concentration.

Changes in serum copper level during detoxification of acutely poisoned drug addicts.

The results of myocardial (99mTc-MIBI SPECT) perfusion scintigraphy according to clinical evaluation, ECG, biochemical factors of necrosis and indicators of carbon monoxide (CO) poisoning severity are described in the paper. Under examination there were 88 young (mean age 26 +/- 8.5) acutely CO poisoned patients without previous cardiac illness history, treated at the Department of Clinical Toxicology Jagiellonian University Medical College in Krakow in 1996 to 2002. Measurement of COHb level, blood lactate concentration, duration of exposure and ECG examination were performed on admission. The enzymes activity ALT, AST, CK, MB-CK, was evaluated after 24-48 h. The severity of CO poisoning was estimated basing on age, duration of exposure, COHb level, blood lactate concentration and the patient neurological state on admission. 99mTc-MIBI SPECT was performed on days 1 to 5 post admission. The abnormalities in scintigraphic scans were assessed according to arbitrary accepted scale (0-IV). Conventional biomarkers creatine kinase, ALT and AST were insufficient for evaluation the heart injury in CO cutely poisoned patients. A statistically significant differences in the blood lactate concentration with regard to degree of scintigraphic changes have been observed. The ECG curves monitored from admission to discharge were analyzed in the study. Tachycardia was observed in all the patients but no statistically significant differences were found between the subgroups divided according to the degree of scintigraphic scans. Conductivity disturbances were detected mainly in patients qualified to higher then the first degree of scintigraphic changes. ECG signs of myocardial ischemia were the most frequent in patients with biggest pathological changes in 99mTc-MIBI scans. The changes in 99mTc-MIBI SPECT were observed in the majority of acutely CO poisoned patients. The mutual dependence of patient's condition based on neurological symptoms, carbon monoxide poisoning severity scoring and the degree of scintigraphy changes was found. The examination performed indicate that 99mTc-MIBI SPECT scintigraphy can be method of choice for evaluation the heart injury in patients after acute CO intoxication.

Clinical and scintigraphic (99mTc-MIBI SPECT) heart evaluation in young acutely carbon monoxide poisoned patients.

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