Comatose states caused by intoxication a twelve-year experience

U članku autori su prikazali 105 bolesnika u komi zbog otrovanja liječenih u dvanaestogodišnjem razdoblju. Lijekovima koji djeluju na CNS bilo je otrovano 66 bolesnika, 6 bolesnika bilo je otrova no lijekovima koji djeluju na ostale organske sustave, 18 bolesnika bilo je otrovano pesticidima a 15 bolesnika etilnim alkoholom. U 58 bolesnika zabilježena je višestruko otrovanje. U IV. stupnju kome bilo je 35 bolesnika, u III. stupnju 31 bolesnik, u II. stupnju 27 bolesnika, u I. stupnju 9 a u komi O. stupnja bila su 3 bolesnika. Ukupni letalitet u komatoznih bolesnika bio je 11,5%. Od 12 umrlih bolesnika 11 je bilo u komi IV. stupnja, a 1 u komi III. stupnja. Opisani su nalazi patoanatomske obdukcije u umrlih bolesnika. Metode ekstrakorporalnog odstranjenja otrova iz krvi (hemodijaliza, hemoperfuzija ih kombinacija obih metoda) primijenjene su u 32 teško otrova na bolesnika. U toj skupini letalitet je iznosio 9,4%, a sva 3 umrla bolesnika bila su u komi IV. stupnja. Rezultati upućuju na potencijalnu veliku djelotvornost ekstrakorporalnih metoda u odstranjenju otrova iz krvi. Autori se zalažu za primjenu tih metoda u bolesnika u dubokoj ili prolongiranoj komi zbog otrovanja, kao i u bolesnika s izraženom teškom kliničkom slikom nakon ingestije letalne doze otrovnih tvari.The study included a total of 105 patients in a state of coma caused by intoxication, who were treated at an intensive care unit over a period of twelve years. Sixty-six patients were intoxicated with drugs that affect the central nervous system, six with drugs that affect the other organs, 18 were intoxicated with pesticides and 15 with alcohol. Fifty-eight patients had taken two or more toxic agents simultaneously. Thirty-five patients were in a state of grade IV coma, 31 were in grade III, 27 in grade II, nine in grade I and three patients were in grade O coma. The overall mortality was 11.5%. Of 12 deceased patients, 11 were in grade IV coma and one was in grade III coma. The autopsy findings are described. Extracorporeal methods for the elimination of toxins from the blood (haemodialysis, haemoperfusion or a combination of the two methods) were applied in 32 heavisly intoxicated patients. The mortality in this group was 9.4%. The three deceased patients were in grade IV coma. The results indicate good applicability of these methods for toxin elimination. Their use in deep or prolonged comatose states caused by intoxication, and in cases of severe intoxication following ingestion of lethal doses of toxic agents is therefore recommended

Poisoning with a large dose of digoxin

Prikazan je tijek bolesti 63-godišnje bolesnice koja je u suicidalnoj namjeri uzela per os oko 10 mg medigoksina. Imala je znakove intoksikacije digitalisom: mučninu i povraćanje, u elektrokardiogramu atrioventrikularnu disocijaciju s fibrilacijom atrija·i koncenrraciju digoksina u plazmi od 19,9 nmol/L. Imala je znakove akutnog zatajenja bubrega i, u povezanosti s renalnom insuficijencijom, poluživot digoksina u plazmi iznosio je od 30 do 90 sati. EKG promjene korigiranog 0-T-intervala i P-T-Q-indeksa bile su u korelaciji s ostalim znakovima intoksikacije digitalisom. Sedmog dana bolesti koncentracija digoksina u plazmi iznosila je 2,5 nmol/L.The paper describes the course of ilness in a 63-year-old woman who ingested 10 mg of medigoxin with suicidal intent. The first signs of poisoning were nausea and vomiting. The electrocardiogram showed sings of atrioventricular dissociation and atrial fibrillation, and serum digoxin concentration was 19.9 nmol/L, The partien1: also had sings of acute renal failure with a renal failure index of 3.9. Digoxin half-life was between 30 and 90 hours, depending on renal damage. ECG signs of digitalis intoxication were in correlation with the corrected 0-T-interva! and P-T-0 index. On the seventh day of the ilness the serum digoxin concentration was 2.5 nmol/L

Combined use of haemodialysis and haemoperfusion in the treatment of organophosphate poisoning

Prikazan je tijek bolesti trojice bolesnika otrovanih inhibitorima acetilkolinesteraze. Sva trojica bila su u stanju kome, a jedan je umjetno respiriran. Sva su trojica podvrgnuta postupku hemodijalize i hemoperfuzije jantarnom smolom istodobno i klinička se slika za kratko vrijeme poboljšala. Trombociti su nakon postupka iznosili prosječno 41% od ishodnih vrijednosti. Raspravlja se o nekim aspektima tih otrovanja.The paper deals with three cases of poisoning with cholinesterase inhibitors. All the three patients were in a comatous state. Simultaneous treatment with haemodialysis and XAD-4 haemoperfusion gave good results. The impairment of the coagulation mechanism poses the greatest disadvantage of this method which in some cases, however, is indispensable to save life

Prvi nalaz kritično ugrožene vrste leptira Maculinea alcon (Denis & Schiffermüller, 1775) (Lepidoptera: Lycaenidae) u panonskom dijelu Hrvatske

The critically endangered butterfly Maculinea alcon was found at the locality Grubišnopoljska Bilogora in August 2006. That is the first finding of this species in the Pannonian part of Croatia and the second in Croatia as a whole. The biology of this critically endangered species is discussed, as well as some aspects of ecology and protection measures.Kritično ugrožena vrsta leptira Maculinea alcon pronađena je u kolovozu 2006. godine na lokalitetu Grubišnopoljska Bilogora. To je prvi nalaz ove vrste na prostoru panonske regije Hrvatske, odnosno drugi za Hrvatsku. U radu se raspravlja o biologiji vrste, nekim aspektima ekologije kao i potrebnim mjerama zaštite ovog kritično ugroženog leptira u fauni Hrvatske

Comatose states caused by intoxication a twelve-year experience

U članku autori su prikazali 105 bolesnika u komi zbog otrovanja liječenih u dvanaestogodišnjem razdoblju. Lijekovima koji djeluju na CNS bilo je otrovano 66 bolesnika, 6 bolesnika bilo je otrova no lijekovima koji djeluju na ostale organske sustave, 18 bolesnika bilo je otrovano pesticidima a 15 bolesnika etilnim alkoholom. U 58 bolesnika zabilježena je višestruko otrovanje. U IV. stupnju kome bilo je 35 bolesnika, u III. stupnju 31 bolesnik, u II. stupnju 27 bolesnika, u I. stupnju 9 a u komi O. stupnja bila su 3 bolesnika. Ukupni letalitet u komatoznih bolesnika bio je 11,5%. Od 12 umrlih bolesnika 11 je bilo u komi IV. stupnja, a 1 u komi III. stupnja. Opisani su nalazi patoanatomske obdukcije u umrlih bolesnika. Metode ekstrakorporalnog odstranjenja otrova iz krvi (hemodijaliza, hemoperfuzija ih kombinacija obih metoda) primijenjene su u 32 teško otrova na bolesnika. U toj skupini letalitet je iznosio 9,4%, a sva 3 umrla bolesnika bila su u komi IV. stupnja. Rezultati upućuju na potencijalnu veliku djelotvornost ekstrakorporalnih metoda u odstranjenju otrova iz krvi. Autori se zalažu za primjenu tih metoda u bolesnika u dubokoj ili prolongiranoj komi zbog otrovanja, kao i u bolesnika s izraženom teškom kliničkom slikom nakon ingestije letalne doze otrovnih tvari.The study included a total of 105 patients in a state of coma caused by intoxication, who were treated at an intensive care unit over a period of twelve years. Sixty-six patients were intoxicated with drugs that affect the central nervous system, six with drugs that affect the other organs, 18 were intoxicated with pesticides and 15 with alcohol. Fifty-eight patients had taken two or more toxic agents simultaneously. Thirty-five patients were in a state of grade IV coma, 31 were in grade III, 27 in grade II, nine in grade I and three patients were in grade O coma. The overall mortality was 11.5%. Of 12 deceased patients, 11 were in grade IV coma and one was in grade III coma. The autopsy findings are described. Extracorporeal methods for the elimination of toxins from the blood (haemodialysis, haemoperfusion or a combination of the two methods) were applied in 32 heavisly intoxicated patients. The mortality in this group was 9.4%. The three deceased patients were in grade IV coma. The results indicate good applicability of these methods for toxin elimination. Their use in deep or prolonged comatose states caused by intoxication, and in cases of severe intoxication following ingestion of lethal doses of toxic agents is therefore recommended

A new gastric juice peptide, BPC - an overview of stomach (stress) organoprotection hypothesis and BPC befitial effects

The possibility that the stomach affected by general stress pathology initiates a conteracting response has not been considered in the stress theory until recently. In this, the stomach as the most sensitive part of gastrointestinal tract, the largest neuroendocrine organ in the body, has been suggested to be a crutial point, from where a full stress response against all noxius stress pathology could be purposefully initiated, mediated and organized. The end result would be a strong protection of all organs invaded by "stress". Consistent with this assumption, this coping response is best explained in terms of "organoprotection" and endogenous organoprotectors (e.g. prostaglandins, somatostatin, dopamine) are proposed as mediators. Such an endogenous counteraction could even be afforded by their suitable application. According to this concept, a new gastric juice peptide, M.W. 40, 000, named BPC, was recently isolated. In this, a 15 amino acid fragment (BPC 157) tought to be essential for this activity was fully characterized and effectively investigated. As it had previously been demonstrated for many organoprotective agents using different models of various tissue lesions, despite the poorly understood final mechanism, practically all organ systems appear to be included into BPC beneficial activity. Relative to the reference standards, these effects have been achieved in many species using very low dosages (mostly ug and ng/kg range) after intraperitoneal, intragastrical as well as intramucosal (local) application. The effect was obvious already after one application. A long lasting activity was also demonstrated. Likewise, it was highly efficacious when applied in many experiments simultaneously with noxious agent or in the already established damage conditions, as well as chronically during a prolonged period. Therefore, it seems that BPC treatment does not share any of the so far known limitations for "conventional organoprotectors". No influence on different basal parameters and no toxicity were observed. Thus, whether these findings would provide a purposeful breakthrough into the stress thepry and whether BPC, as a likely endogenous free radical scavenger and organoprotection mediator, would be a useful prototype of a new class of drugs, organoprotective agents, remains to be seen