Jacek Sein Anand

Publications of Jacek Sein Anand

• [Management of acute cyanide poisoning--Polish Medical Society, Section of Clinical Toxicology position statement].

  Authors: Zbigniew Kołaciński, Piotr Burda, Magdalena Łukasik-Głebocka, Jacek Sein Anand

  Przegla̧d lekarski. 01/2011; 68(8):459-62.

  Paper presents Polish Medical Society, Section of Clinical Toxicology position statement on the prehospital and hospital management of cyanide poisoning.

• [Accidental intoxication with eucalyptus oil--a case report].

  Authors: Wojciech Waldman, Małgorzata Barwina, Jacek Sein Anand

  Przegla̧d lekarski. 01/2011; 68(8):555-6.

  Eucalyptus oil (EO) intoxications are rare. We present a case of 58 yrs old chemist, who due to intense delusions consumed 4-5 drops of concentrated EO in order to self-medication of ascariasis.Eucalyptus oil (EO) intoxications are rare. We present a case of 58 yrs old chemist, who due to intense delusions consumed 4-5 drops of concentrated EO in order to self-medication of ascariasis. Despite the low dose of ingested xenobiotic the course of poisoning was severe. The intoxication was complicated with acute lung and heart injury, tachycardia and hypertension. Most of the clinical symptoms and biochemical abnormalities disappeared after the treatment.

• [Laboratory investigations in acute olanzapine poisonings].

  Authors: Krzysztof Ciszowski, Jacek Sein Anand, Jolanta Wilimowska, Wojciech Jawień

  Przegla̧d lekarski. 01/2011; 68(8):417-21.

  Olanzapine is an atypical antipsychotic with multireceptor affinity and different pharmacological effects, which can result with abnormalities in laboratory investigations. To assess the nature andOlanzapine is an atypical antipsychotic with multireceptor affinity and different pharmacological effects, which can result with abnormalities in laboratory investigations. To assess the nature and frequency of laboratory tests abnormalities in patients with an acute olanzapine poisoning. Material: 26 adult cases (mean age 37.7 +/- 15.3 years) of an acute olanzapine poisoning (serum level above 100 ng/mL). Group consisted of 11 men and 13 women, but 1 man and 1 woman were poisoned twice. Prospective analysis of the following laboratory parameters: complete blood count (CBC), coagulation tests (APTT, INR), serum concentration of sodium, potassium, chlorides, glucose, BUN, creatinine and bilirubin, serum activity of AST, ALT, GGTP and CPK, urinalysis. The most common laboratory abnormalities in the study group were: hyperglycaemia (96%), hyper-prolactinaemia (83%), elevated CPK (80%), hypokalaemia (75%), hyperbilirubinaemia (60%), leukocytosis (55%). Less frequent parameters were: elevated AST (20%), hyponatraemia (15%), elevated ALT(10%) and thrombocytopenia (5%). The onset of some parameters was as follows: 1st day of hospitalization hyperglycaemia, leukocytosis and hypokalaemia, 2nd - hyperbilirubinaemia and elevated CPK, and 3rd - hyperprolactinaemia. In acute olanzapine poisonings: (1) muscle and liver injury, serum glucose and electrolytes abnormalities, and changes in CBC can be present; (2) the valuable parameters for the monitoring of the course of poisonings are: serum activity of CPK and transaminases (AST, ALT), serum level of bilirubin, glucose, potassium and sodium, and CBC; (3) hyperprolactinaemia probably lacks of practical importance, but the further investigations are needed in this area.

• [Electrocardiographic abnormalities in acute olanzapine poisonings].

  Authors: Krzysztof Ciszowski, Jacek Sein Anand

  Przegla̧d lekarski. 01/2011; 68(8):422-5.

  Olanzapine is an atypical antipsychotic used for many years in the treatment of schizophrenia and bipolar disorder. Poisonings with this medicine can results with cardiotoxic effects in the form ofOlanzapine is an atypical antipsychotic used for many years in the treatment of schizophrenia and bipolar disorder. Poisonings with this medicine can results with cardiotoxic effects in the form of ECG abnormalities. To evaluate the nature and incidence of electrocardiographic abnormalities in patients with acute olanzapine poisoning. 23 adult (mean age 38.4 +/- 15.5 years) patients with acute olanzapine poisoning, including 10 men (30.4 +/- 8.1 years) and 11 women (45.7 +/- 17.2 years), where 1 man and 1 woman were poisoned twice. The toxic serum level of olanzapine (above 100 ng/mL) was confirmed in each patient. Evaluation of electrocardiograms performed in patients in the first day of hospitalization with automatic measurement of durations of PQ, QRS and QTc and the identification of arrhythmias and conduction disorders on the basis of visual analysis of the ECG waveforms. Statistical analysis of the results using the methods of descriptive statistics. The mean durations of PQ, QRS and QTc in the study group were as follows: 135 +/- 23 ms, 91 +/- 12 ms, and 453 +/- 48 ms, respectively. The most common ECG abnormalities were prolonged QTc and supraventricular tachycardia (including sinus tachycardia) - each 22%; less common were ST-T changes (17%) and supraventricular premature complexes (9%), and only in individual cases (4%) ventricular premature complexes, bundle branch block, sinus bradycardia and atrial fibrillation were present. In the course of acute olanzapine poisonings: (1) prolonged QTc interval is quite common, but rarely leads to torsade de pointes tachycardia; (2) fast supraventricular rhythms are also common, but rarely cause irregular tachyarrhythmias, eg. atrial fibrillation; (3) conduction disorders (atrioventricular blocks, bundle branch blocks) are not typical abnormalities; (4) the observed ECG abnormalities emphasize the need of continuous ECG monitoring in these patients.

• [Selected data of acute intoxications with glycol and methanol in Poland in the year 2009].

  Authors: Jacek Sein Anand, Aleksandra Swiderska, Janusz Pach, Piotr Burda

  Przegla̧d lekarski. 01/2011; 68(8):453-8.

  There are no reliable studies in Poland evaluating the scale of acute intoxications with different types of xenobiotics. The aim of the study was to evaluate selected problems referring to theThere are no reliable studies in Poland evaluating the scale of acute intoxications with different types of xenobiotics. The aim of the study was to evaluate selected problems referring to the patients intoxicated with glycol and methanol, who were given the medical treatment in all Toxicological (TUs) and Intensive Care Units (ICUs), having contract with Polish National Fund of Health, in the year 2009. All cases of acute intoxications treated in Polish hospitals in 2009 and reported to the Polish National Fund of Health were included to the analysis. To further analysis were chosen only those patients, whose main diagnosis or comorbidities were coded as T51.1 or T52.3 according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision and, according to the state of health, patients were treated in TUs and ICUs. All the cases, in which intoxication was not the main health problem were excluded. There were 85 398 acute intoxications in Poland in 2009, 470 of them referred to glycol and methanol poisonings. 192 patients were treated in TUs and ICUs. The most common methods of therapy in those units were extracorporeal toxin removal (60.2% in TUs and 62.5% in ICUs) and conservative treatment (39.8% in TUs and 37.5% in ICUs). The mortality rate in glycol and methanol poisonings in TUs and ICUs were 24.2%, and 56.3% respectively. In the conservatively treated group the mortality rates in TUs and ICUs were 23.5%, and 66.7% respectively, while in extracorporeal toxin removal group the mortality rates in TUs and ICUs were 24.7%, and 50% respectively. The authors also observed two regions (Maków Mazowiecki and Słubice), in which the amount of glycol and methanol intoxications was much higher than in the rest part of the country. 1. All the cases of acute intoxications of glycol and methanol should be consulted with Polish Poison Control Centers. 2. It is necessary to establish diagnostic and treatment protocols for intoxicated patients in Poland. 3. There is a strong need for popularization of the modern methods of glycol and methanol poisonings therapy and increasing the availability of modern antidotes. 4. It is necessary to monitor diagnostics, treatment and mortality rate of glycol and methanol intoxicated patients in all types of hospital units in Poland. 5. There is a need of further toxicological education of medical students and doctors as well. 6. The cases of abnormally high rate of glycol and methanol intoxications in some hospitals should be investigated.

• [Reactive oxygen species and 3,4-dihydroxyphenylacetaldehyde in pathogenesis of Parkinson disease].

  Authors: Iwona Rybakowska, Grzegorz Szreder, Krystian Kaletha, Małgorzata Barwina, Wojciech Waldman, Jacek Sein Anand

  Przegla̧d lekarski. 01/2011; 68(8):486-7.

  Reactive oxygen species, which plays a role in pathogenesis of many neurodegenerative diseases, seems to be important also in pathogenesis of the Parkinson's disease. Experiments performed recently,Reactive oxygen species, which plays a role in pathogenesis of many neurodegenerative diseases, seems to be important also in pathogenesis of the Parkinson's disease. Experiments performed recently, revealed in the cerebrum of patients suffering from this disease (induced by the oxidative stress) elevated levels of 3,4-dihydroxyphenylacetaldehyde (DOPAL)--a strong endogenous neurotoxin to dopamine neurons.

• [The clinical picture of acute olanzapine poisonings].

  Authors: Krzysztof Ciszowski, Jacek Sein Anand, Jolanta Wilimowska, Wojciech Jawień

  Przegla̧d lekarski. 01/2011; 68(8):426-33.

  Olanzapine is a second generation antipsychotic of thienobenzodiazepin group, which is used in the treatment of schizophrenia, bipolar disorder, and others, mainly psychiatric. Its multireceptorOlanzapine is a second generation antipsychotic of thienobenzodiazepin group, which is used in the treatment of schizophrenia, bipolar disorder, and others, mainly psychiatric. Its multireceptor action (antagonism to dopaminergic D1, D2, D4, serotoninergic 5-HT2A, 5-HT2C, histaminergic H1, cholinergic M1-5, and a1--adrenergic receptors) results in multiple clinical symptoms in the course of acute poisoning. Evaluation of incidence and intensity of clinical symptoms in patients with of acute olanzapine intoxication. The pathophysiological mechanisms of particular symptoms are also described. 26 patients (mean age 37.7 +/- 15.3 years) hospitalized in 2005-2008 in toxicological centers in Krakow and Gdansk because of acute olanzapine poisoning (all patients had the toxic serum level of olanzapine above 100 ng/mL). The study group consisted of 11 men (29.3 +/- 8.5 years) and 13 women (44.9 +/- 16.4 years); 1 man and 1 woman were poisoned twice. Prospective analysis (using descriptive statistics) of data taken from medical anamnesis and results of physical examination, considering the following ones: consciousness disturbances (Glasgow Coma Scale, Matthew's scale, qualitative disturbances), vital signs (arterial blood pressure, heart rate, breathing rate, temperature), neurological findings (muscular tension, tendon reflexes, extrapyramidal symptoms, pupils) and others (oral and bronchial secretion, Poisoning Severity Score). The mean dose of ingested olanzapine in the study group was 352.5 +/- 220.0 mg, while the mean time since ingestion to hospital admission was 4.4 +/- 3.5 h. The half of the patients took other medicines together with olanzapine, and 23% consumed alcohol, as well. The following intensity of quantitative consciousness disturbances according to Matthew's scale were observed: grade 0 - 8%, I - 15%, II - 23%, III - 50%, and IV - 4%. The minimal and maximal values of blood pressure were: 102/63 +/- 16/14 and 163/ 97 +/- 27/18 mmHg, respectively; heart rate: 77 +/- 15 and 138 +/- 22 beats/min; temperature: 36.3 +/- 0.5 and 37.9 +/- 0.8 degrees C; breathing rate in non-intubated patients: 14 +/- 2 and 22 +/- 7 breaths/min. The mean duration of consciousness disturbances, endotracheal intubation and mechanical ventilation were: 44.9 +/- 31.3; 22.0 +/- 33.3 and 7.0 +/- 25.9 h, respectively. The study revealed tachycardia (85%), psychomotor agitation (81%), hypertension (73%), miosis (65%), and coma (54%) as the most common symptoms of poisoning. The hospitalization of poisoned patients lasted on average 5.7 +/- 3.6 days and the half of them were poisoned severely (PSS 3). In the course of acute olanzapine poisoning: (1) the prevailing symptoms come from circulatory and central nervous systems; (2) some symptoms are mutually opposed, eg.: coma - psychomotor agitation, hypertension - hypotension, tachycardia - bradycardia, hyperthermia - hypothermia, miosis - mydriasis; (3) rarely consciousness disturbances may persist for up to 6 days after olanzapine overdose; (4) the course of poisoning can be severe, sometimes complicated, but fatal outcomes are rare.

• [Unusual cases of anisocoria--report of two cases].

  Authors: Joanna Jankowska-Folusiak, Małgorzata Barwina, Jacek Sein Anand

  Przegla̧d lekarski. 01/2011; 68(8):553-4.

  We presented two cases of anisocoria involved with accidental intoxication of mydiatrics. Both patient were in good health condition and did not have any anomalies in ophtalmological and neurologicalWe presented two cases of anisocoria involved with accidental intoxication of mydiatrics. Both patient were in good health condition and did not have any anomalies in ophtalmological and neurological examinations. An asymmetry of papilla receded spontaneously. Anisocoria was not the symptom of any systemic illness.

• [Iatrogenic hypernatremia--report of two cases].

  Authors: Marek Wiśniewski, Wojciech Waldman, Jacek Sein Anand

  Przegla̧d lekarski. 01/2011; 68(8):557-9.

  Despite the many side effects solutions of kitchen salt are still being used as efficient and safe homemade emetics. Saturated solutions of kitchen salt have been used by paramedics to provokeDespite the many side effects solutions of kitchen salt are still being used as efficient and safe homemade emetics. Saturated solutions of kitchen salt have been used by paramedics to provoke vomiting in two patients: a 50-years-old woman and a 44-years-old man. According to anamnesis patients received respectively around 330 and 500 g of dissolved kitchen salt. In both cases bloody emesis and bloody diarrhea, alteration of consciousness and low blood pressure were noted. Maximum blood sodium level was 177 and 173 mmol/l respectively. Due to signs of gastrointestinal bleeding gastric endoscopy was performed in both cases, which demonstrated widespread damage of gastric mucosa. Normalization of electrolyte disturbances and improvement of patients' status was achieved with intravenous infusion of 5% glucose. Both patients have been discharged to further outpatient treatment after 10-days hospitalization. 1. Use of salt kitchen solutions to induce emesis results in a high risk of life-threatening complications. 2. Particular emphasis must be put on training of paramedics in pre-hospital management of acute poisonings.

• [Psychosis caused by the treatment with clarithromycin--a case report].

  Authors: Iwona Trzebiatowska, Małgorzata Barwina, Wojciech Waldman, Jacek Sein Anand

  Przegla̧d lekarski. 01/2011; 68(8):560-1.

  We present a case of psychosis caused by intake of clarithromycin in a young, healthy patient. Disturbance of consciousness occurred a few hours after the intake of the first dose and persisted forWe present a case of psychosis caused by intake of clarithromycin in a young, healthy patient. Disturbance of consciousness occurred a few hours after the intake of the first dose and persisted for four days after drug discontinuation. Conducted numerous medical tests excluded other possible causes of psychotic disorders. The patient was observed in hospital, without using antipsychotic preparations up to the spontaneous resolution of the aforementioned disorders.

• [Resurgence in paramethoxamphetamine use. Review of poisonings and two recent cases study].

  Authors: Maria Kała, Wojciech Lechowicz, Agnieszka Skulska, Małgorzata Barwina, Jacek Sein Anand

  Przegla̧d lekarski. 01/2011; 68(8):548-52.

  Two recent cases of death due to p-methoxyamphetamine (PAM) intake, a methoxylated phenethylamine derivative, were described and compared with previous PMA related deaths that occurred in manyTwo recent cases of death due to p-methoxyamphetamine (PAM) intake, a methoxylated phenethylamine derivative, were described and compared with previous PMA related deaths that occurred in many countries. Following a review of the available literature from 1974 to 2011 three periods of resurgence of an unsuspected increase of lethal PMA causation were considered. Signs of intoxications, concentrations of PMA found in biological materials were discussed. Based on the case reports can be concluded the great number of victims were unconscious of taking PMA as substitute of MDMA. Two new methods for screening, identification and quantification of amphetamine derivatives in biosamples (blood and urine) using LC-MS/MS techniques were developed. The methods have proven to be appropriate for clinical and forensic toxicology purposes.

• [SPAD--new possibilities?].

  Authors: Marek Wiśniewski, Małgorzata Barwina, Maciej Zajac, Jacek Sein Anand

  Przegla̧d lekarski. 01/2011; 68(8):483-5.

  The number of patients admitted to toxicological units due to acute liver failure (ALF) and acute-on-chronic liver failure (AoChLF) has been increasing in recent years. Various methods ofThe number of patients admitted to toxicological units due to acute liver failure (ALF) and acute-on-chronic liver failure (AoChLF) has been increasing in recent years. Various methods of extracorporeal liver support have been described in this paper, with particular emphasis on modified single pass albumin dialysis (SPAD). Conclusions: 1. Single pass albumin dialysis (SPAD) is a promising method of extracorporeal liver support. 2. Due to widespread availability of continuous renal replacement therapy equipment it can be performed in most units providing intensive care. 3. No additional costs due to purchase of equipment or training of personnel are necessary to perform SPAD. 4. Further studies are necessary to establish optimal concentration of human albumin in dialysate and flow rates of blood and dialysate during the procedure. 5. Development of biocompatible replacement of human albumin would promote more frequent use of SPAD.

• Acute dermal and inhalation exposure to 4-vinylpyridine--a case report.

  Authors: Jacek Sein Anand, Małgorzata Barwina, Roman Korolkiewicz

  Przegla̧d lekarski. 01/2011; 68(8):546-7.

  To the best of our knowledge there are only few reports in medical literature concerning the acute dermal exposure to 4-Vinylpyridine (4-VP). We describe a dermal and inhalation exposure to 4-VPTo the best of our knowledge there are only few reports in medical literature concerning the acute dermal exposure to 4-Vinylpyridine (4-VP). We describe a dermal and inhalation exposure to 4-VP followed by systemic symptoms and local injury. A 58-year old female, with non significant previous medical history, was admitted to the ward with the signs of vertigo, weakness and local pain in the foot dorsal region after exposition to few drops of 4-VP. After 7 days of the treatment all symptoms resolved. Vinylpyridines are irritant and corrosive substances which can lead to skin damage. In case of inhalation exposure the late onset of systemic symptoms should be taken into account.

• [Visual impairment caused by recreational usage of cocaine--a case report].

  Authors: Jacek Sein Anand, Wojciech Waldman, Małgorzata Barwina

  Przegla̧d lekarski. 01/2010; 67(8):623-4.

  We presented a case of sudden and painless vision impairment connected with the recreational usage of cocaine. According to many authors illicit use of cocaine has been associated with the mostWe presented a case of sudden and painless vision impairment connected with the recreational usage of cocaine. According to many authors illicit use of cocaine has been associated with the most common adverse effect among all psychoactive drugs. In the last years there were a few articles about vision problems after the usage of cocaine. In most cases the main mechanism was central retinal artery occlusion (CRAO). The vision impairment developed from 3 to 10 hrs after the cocaine use and the outcome, despite the intensive treatment, was usually poor. All doctors should keep in mind the possibility of cocaine usage, in young and healthy people, who developed a sudden and painless vision loss.

• [Selected cases of acute intoxication with metallic mercury].

  Authors: Jacek Sein Anand, Małgorzata Barwina, Tadeusz Ossowski

  Przegla̧d lekarski. 01/2010; 67(8):625-7.

  We presented six different cases of poisoning with metallic mercury, which were hospitalized between the year 1999 and 2010 in toxicological center in Gdańsk. We discussed also the mechanism, methodWe presented six different cases of poisoning with metallic mercury, which were hospitalized between the year 1999 and 2010 in toxicological center in Gdańsk. We discussed also the mechanism, method of diagnosis and therapy of this type of intoxication.

• [Pathomechanism of vitamin D intoxication].

  Authors: Iwona Rybakowska, Jerzy Klimek, Krystian Kaletha, Jacek Sein Anand

  Przegla̧d lekarski. 01/2010; 67(8):643-4.

  Pathomechanism of vitamin D intoxication is still unclear. Experiments on animals showed that intoxication is accompanied by distinctly elevated serum level of vitamin D precursor [25(OH)D3] but notPathomechanism of vitamin D intoxication is still unclear. Experiments on animals showed that intoxication is accompanied by distinctly elevated serum level of vitamin D precursor [25(OH)D3] but not by that of hormonally, metabolic active form of it [1alpha,25(OH)2D3]. The most probable explanation of this phenomenon is that vitamin D precursor releases hormonal form of vitamin from its binding with serum transporting protein (DBP) stimulating in this way transcription of genes in cells of target tissues.

• Acute intoxication with Tricholoma equestre--clinical course.

  Authors: Jacek Sein Anand, Paweł Chwaluk

  Przegla̧d lekarski. 01/2010; 67(8):617-8.

  We observed all patients admitted to the poison centers for children and adults in Gdańsk and Biała Podlaska, between the years 2001 and 2010, who were intoxicated with Tricholoma equestre. The mainWe observed all patients admitted to the poison centers for children and adults in Gdańsk and Biała Podlaska, between the years 2001 and 2010, who were intoxicated with Tricholoma equestre. The main clinical symptoms, included muscle weakness, nausea without vomiting, diaphoresis without fever, and in the most serious cases acute respiratory failure. In biochemical results there were seen marked increase in CK, AST and ALT levels. The mortality rate was 20%. It seems that the severity of intoxication are correlated with the amount of ingested mushroom. CONCLUSIONS: Physicians should be aware of the possibility of acute intoxications after repeated consumption of large quantities of Tricholoma equestre. The clinical picture of poisonings with this wild mushroom might be different in children and adults and depends on ingested amount of these mushrooms. The most serious adverse effect include acute respiratory failure and myocarditis with cardiac arrhythmia and cardiovascular collapse. Intoxication of Tricholoma equestre may be connected with the high mortality rate about 20%.

• [Selected data concerning acute intoxications with xenobiotics in Poland in the year 2009].

  Authors: Jacek Sein Anand, Aleksandra Swiderska

  Przegla̧d lekarski. 01/2010; 67(8):559-65.

  There are no reliable studies in Poland evaluating the amount of acute intoxications by drugs, chemical substances, animal venom, plant toxins. The aim of the study was to evaluate selected problemsThere are no reliable studies in Poland evaluating the amount of acute intoxications by drugs, chemical substances, animal venom, plant toxins. The aim of the study was to evaluate selected problems referring to intoxicated patients, who were given medical treatment in all hospitals having contract with National Fund of Health in 2009. All medical interventions, in which the main diagnosis were coded as T36-T65 (with four-character subcategories) according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision, were involved to the study. Also all poisonings with those codes put as comorbidities and positively verified by the authors, were included to the analysis. There were 85 398 acute intoxications in Poland in 2009. In 42 002 cases there were no need of further hospital treatment. Ethanol poisonings were the most common diagnosis among patients treated in the Emergency Departments. Intoxication with drugs were dominant among patients admitted to hospitals. The average hospitalization in Toxicology Centers lasted 3,6 days while in other hospitals about 3 days. There is the high percentage of discharges on "patient's demand" (about 13% of all hospitalizations). In Toxicological Units this kind of discharges reaches up to 19%. In 2009 there were 491 deaths because of acute intoxications. It presents 1.13% of all hospitalizations. It's worth to indicate that the mortality rate in critical care departments has reached the level of 14.41%, while in Toxicology Centers the mortality rate was 1.13% in all cases and less than 4% in most severe poisonings. 1. In Poland, as it is in other countries, the national toxicological information and control system should be brought into being. The system should be based on existing Toxicology Centers. 2. Taking into consideration the high mortality rate outside the Toxicological Units, there is a need nurses and other medical staff. 3. It's necessary to monitor permanently diagnostics, treatment and mortality rate of intoxicated patients in Poland.

• [The lower legs amputation--rare side effects of acute poisoning].

  Authors: Jacek Sein Anand, Małgorzata Barwina, Anna Wiśniewska

  Przegla̧d lekarski. 01/2010; 67(8):621-2.

  The paper describes a case of suicidal poisoning with a combined hypotensive drug. CASE REPORT: A 46-year old man ingested, with a suicidal intent, a 0.5 l of vodka and around 20 tabl. of TarkaThe paper describes a case of suicidal poisoning with a combined hypotensive drug. CASE REPORT: A 46-year old man ingested, with a suicidal intent, a 0.5 l of vodka and around 20 tabl. of Tarka contains 180 mg of verapamil and 2 mg of trandolapril in 1 tablet. Despite intensive supportive treatment no reperfusion was achieved, and it was necessary to amputate both legs below knees. CONCLUSIONS: Acute overdoses of Tarka may be severe in spite of relatively small amounts of drug ingested by patients (from 5 to 20 tablets). In light of reports of severe ischemic complications, which seem to have thrombotic etiology, it seems advisable to employ prophylaxis with anticoagulants, especially in patients with resistant hypotension. Ischemic complications, which may result in amputation, may present long time after hemodynamic stabilization is achieved.

• Mosapride and postoperative ileus.

  Authors: Roman Korolkiewicz, Jacek Sein Anand

  Diseases of the colon and rectum. 05/2009; 52(4):751-2.