Tricyclic antidepressant overdose: incidence of symptoms

Forty consecutively hospitalized patients who had overdosed primarily with a tricyclic antidepressant (TCA) were observed until discharge. The severity of the overdose was documented by serial measurements of plasma TCA levels. Nineteen of the patients became comatose, 16 required supportive respiration, and 2 died. Individual symptoms in the 13 patients having plasma TCA levels greater than 1,000 ng/ml are shown. Plasma TCA measurements more reliably define patients who are at risk for major medical complications following overdose than does the amount of drug ingested by history. In the absence of plasma measurements, a QRS duration of 100 msec or more on a routine ECG within the first 24 hours defined all patients with major TCA overdoses.     

Antithrombin III, Antifactor Xa and Heparin

Methods have been devised for the measurement of antithrombin and of the natural inhibitor of activated factor X.
The relation between heparin and its plasma cofactor and the destruction of thrombin and activated factor X were studied. As observed by other workers, heparin has more effect on the speed of thrombin neutralized than on the amount neutralized after 1 hr of incubation. When the neutralization of activated factor X was studied it was found that heparin at very low concentrations, with a plasma cofactor, promoted the progressive destruction of activated factor X.     

Cyclosporin A is associated with faster engraftment and less mucositis than methotrexate after allogeneic bone marrow transplantation

S ummary . Thirty-eight patients with severe aplastic anaemia or acute leukaemia received HLA-identical sibling marrow transplants. Seventeen were treated with methotrexate and 21 with cyclosporin A (CyA) to minimize graft-versus-host disease post transplant. Marrow engraftment was more rapid and oropharyngeal mucositis less severe in those receiving CyA. This resulted in a shorter period of neutropenia and thrombocytopenia, fewer platelet and granulocyte transfusions and less fever. These benefits have to be weighed against the increased nephrotoxicity of CyA.     

Recurrent encephalitis with elevated titers for herpes simplex.

An 8-year-old boy was seen on two occasions 14 months apart with signs and symptoms of encephalitis. The clinical course and laboratory studies were highly suggesive of herpes simplex infection during both episodes.