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Clinico-anatomical analysis, chemico-toxicological and histological examination of material from 54 deceased from intoxication with azaleptin both in urgent toxicology department and pre-admission stage, were performed. Morphology of intoxication with azaleptin was studied, structural base of genopathy at these intoxications was developed.

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The case study is dedicated to morphological changes occurring in the organs and tissues in lethal outcomes due to acute poisoning with narcotic substances; it is also dedicated to the structure of an acute respiratory insufficiency in unexpected "heroin" death and to delayed death after intoxication. The clinical-and-anatomical analysis of the material, involving the immunological, biochemical, chemical and spectral examination data, has been undertaken.

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Thirty-eight patients with mushroom (Paxillus involutus and Paxillus atrotomentosus) poisoning were treated. Slight poisoning (acute gastroenteritis) was diagnosed in 17 patients, medium-severe in 13, severe in 6, and extremely severe in 2 patients. Changes in the LPO-AOD system correlated with the severity of hepatorenal involvement. The treatment included hepatotropic therapy; patients with acute renal failure were treated by hemodialysis. Paxillus mushrooms induced functional evacuatory disorders in the small intestine. Eleven patients with adhesions in the abdominal cavity developed ileus. Two patients died: a man aged 26 years after eating fried (not boiled) mushrooms and a woman aged 76 years with ileus with symptoms of multiple organ dysfunction. The rest patients were discharged from hospital in satisfactory condition. Clinical course of poisoning with Paxillus mushrooms is discussed.

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Clinical anatomical analysis, forensic chemical, morphological, bacteriological, and immunological investigations of material from 62 subjects dead from acute poisoning with opiates before hospitalization (31 cases) and in hospital (31 cases) were carried out. Organ and tissue lesions typical of opiate poisoning were detected. The outcome of acute poisoning with opiates is largely determined by severe dystrophic and inflammatory processes in organs and tissues, typical of narcomaniacs.

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Study of the relationship between activated charcoal potential and its effects and the biological media and organic toxic agents is in progress. Using the electrochemical model of hemoperfusion proposed previously, the authors defined the optimal conditions for modifying the hemoadsorbents from activated charcoal, carried out monitored hemoperfusion detoxication in patients, and improved the results of treatment in patients with acute poisonings with organophosphorus compounds, psychotropic and soporific agents, and with 1,2-dichloroethane.

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A total of 114 autopsy specimens and 34 specimens of surgical material from patients with the myorenal syndrome are analyzed. All patients had symptoms of acute renal (hepatorenal) failure which caused death during the first two weeks of the disease. In later periods, death was caused by septic complications. Manifest morphological changes, caused by injuries, metabolic disorders, or sepsis were detected in many organs and tissues in all cases. The sources of septic complications were wounds, decompression incisions, fasciotomies, shunts, and catheters. After combined therapy of wounds with adsorbents, antibiotics, proteolytic enzymes, and laser exposure the bacteria lost their virulence and died and the wounds were cleansed.

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Clinico-anatomical analysis of surgical material (32 cases) and 86 autopsy cases of myorenal syndrome (crush syndrome) is presented. Clinically in all cases there were symptoms of acute renal (hepatico-renal) failure which was a cause of death during the first 2 weeks. Septic complications were a cause of death at later periods. Grave alterations of traumatic, metabolic and septic origin were found in many organs in all cases. The sources of sepsis were decompressing longitudinal cuts and fasciotomies, shunts, lacerated wounds, catheters. Combined local treatment of wounds with sorbents, antibiotics, proteolytic enzymes, quantum therapy facilitated the destruction of bacteria and loss of their activity, wound purification and thus allowed coping with septic complications.

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The article deals with investigation of dynamics of clinical morphological pattern in acute poisoning with organophosphorous insecticides. For this purpose all specific and non-specific effects of this chemical disease are classified according to the moment of their occurrence after poison exposure. Morphological equivalent of specific clinical manifestations at different stages of thanatogenesis of this poisoning was determined. It was shown that intensity of pathological process or specific density of toxic effects per time-unit is a very important criterium for assessment of severity and prognosis of poisoning.

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Changes in plasma fibronectin (FN) levels in acute toxic conditions have been studied in 24 patients. A significant reduction of FN concentration was found within the first days of the disease; further changes in the FN levels are related to the disease outcome and have a prognostic value. An inverse correlation was found between the FN concentration and other blood biochemical parameters (LDH, creatinine, and urea). Developed renal insufficiency in the presence of hypofibronectinemia suggests a poor prognosis of the disease.

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The results of treatment of 36 patients injured during the earthquake in Armenia are analyzed. The patients had severe traumas: open injuries to the limbs, complicated by nephro- and hepatopathies. The periods of the limb crushing with fragments of ruined buildings varied from 3 hours to 3 days. The treatment modalities included conservative and operative detoxication (hemoperfusion, hemodiafiltration, hemofiltration, prolonged endolymphatic infusions of drugs), active surgical strategy, rehabilitation of patients. Seven amputations, 7 reamputations, and 21 necrectomies were performed in 36 patients by vital indications; no lethal outcomes were recorded. Restorative skin plasty was performed in 14 patients with 19 limb stumps, with good functional outcomes. The patients were directed to the Central Research Institute of Prosthetics to be supplied with prostheses. Only in 3 patients with the upper limb crushing the development of stable ischemic contractures could not be prevented.

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Upon clinical and pathological analyses of the evidence obtained on drug-related lethal nephropathies (51 cases) and hepatopathies (14 cases) as well as at puncture biopsies of the livers affected by chemotherapeutic agents it was determined that the commonest variants of the disturbances were tubular nephropathies, tubular-interstitial nephritis, papillary renal necrosis, symmetric cortical renal necrosis, fulminant hepatopathies with diffuse massive necrosis of hepatocytes. For biopsies, cholestatic drug-induced hepatopathies were found most frequently. As a rule, the patients received polychemotherapy with psychotropic, cardiovascular and antidiabetic drugs, nonsteroids, antibiotics, sulfanilamides, consumed contrast diagnostic media. The attention is drawn to considerable diagnostic difficulties faced in drug-induced damage to the organs which can be diminished by comparisons between clinical and morphological findings.

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Clinical and morphologic analysis of material from 39 patients who died from the myorenal syndrome is given. It is shown that during last 10 years the mortality rate from this syndrome is markedly reduced from 55 to 14% due to new active methods of detoxication. The main morphologic manifestations of the syndrome remain the skeletal muscles necrosis and hemoglobinuric nephrosis leading to acute renal failure. The author describes morphologic, histochemical and electron microscopic features of these lesions. It is noted also that progress in the treatment changed the whole structure of mortality, and the role of new complications, mainly septicemia, was increased. The sources of septicemia are both skin and muscles lesions and catheters and shunts used in modern methods of treatment.

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Structural alterations in the kidneys of 40 patients deceased from carbon tetrachloride (CCl4) poisoning were examined. All the patients had died with severe acute hepatic and renal failure. The authors found that it was consecutively developing hydropic and protein dystrophy of both proximal and distal tubules which accounted for acute renal failure. Changes in the glomeruli of the type of membranous glomerulopathy were also found. In the authors' opinion, the main cause of these alterations of the kidneys was presumably severe hepatic insufficiency with metabolic and immune disturbances.

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The liver and kidneys of 48 persons who had died of poisoning with ethyleneglycol were investigated at periods from 4 hours to 32 days following the poisoning. In 44 deceased who had died 2--32 days after the poising of acute renal and hepato-renal insufficiency there were revealed lesions characteristic of this intoxication. The structural basis of glycolic nephrosis and hepatosis was hydropic dystrophy of the nephrothelium of proximal and distal tubules and of hepatocytes of the centers of the liver lobules with outcome into colliquative necrosis through ballon dystrophy. Specific lesions of thekidney and liver may be accounted for by a high osmotic activity of ethyleneglycol and products of its metabolism; these were captured by the renal and hepatic epithelium in the process of reabsorption and pinocytosis increasing drastically the osmotic concentration of the intracellular liquid, which was accompanied by rapid inflow of water into the cell and its hydropic dystrophy.

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Acute renal insufficiency (ARI) -- one of the most frequent manifestations of many exogenous intoxications. On the ground of a morphological investigation of 625 kidneys in poisoning with various poisons, the authors have come to the conclusion that the acute nephrotic syndrome is the basis of ARI in a "toxic" kidney". A morphological classification of the nephrotic syndrome is given: necrotic nephrosis hydropic nephrosis (glycolic nephrosis), cortical necrosis of the kidney, excretory nephrosis, acute lipid nephrosis. Morphological characteristics of the nephrotic syndrome forms referred to above are presented. Lesions of the kidney in exogenous intoxications are caused first of all by the direct toxic action of a poison. Toxic shock is an important factor in the development of ARI.

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