Massive lamotrigine and bupropion overdose resulting in status epilepticus without cardiovascular collapse.

An 18 year-old woman presented to an outside hospital with seizure activity after a massive ingestion of lamotrigine, bupropion, trazodone, buspirone, and possibly isoretinoin. Her initial vital signs were remarkable for tachycardia (120 bpm). She was intubated for airway protection. For treatment of status epilepticus, she received a total of 12 mg of IV lorazepam along with a lorazepam infusion titrated to 15 mg/hr, a propofol infusion of unknown dosing, and phenobarbital 650 mg. She was transferred to a receiving hospital. Her initial ECG at the receiving hospital showed a QRS of 117 ms which narrowed with 50 mEq of sodium bicarbonate after approximately 6 hours. She required norepinephrine intermittently for blood pressure support for approximately 2 days. The patient had no dysrhythmias. EEG showed no epileptiform activity from approximately 11 hours-32 hours post ingestion. At the receiving hospital, her serum lamotrigine concentration was 109 mcg/mL (reference 3.0-14.0 mcg/mL) 7 hours after ingestion. Her bupropion concentration was 92 ng/mL (reference 50-100 ng/mL). She was extubated on hospital day 5 and discharged to a psychiatric facility on hospital day 13.

Association of demographic and treatment variables in long-term colon cancer survival.

The purpose of this study is to examine demographic and treatment variables because they relate to 5-year survival in colon cancer. The study design is analysis of 174 471 patients with colon and rectosigmoid cancer as reported to the American College of Surgeons National Cancer Data Base. Factors associated with a reduced risk of mortality included female gender (hazard ratio = 0.89; 95% confidence interval, 0.87-0.90), education status (hazard ratio = 0.87; 95% confidence interval, 0.85-0.89), increased number of lymph nodes resected (compared with <8, 8-12: hazard ratio = 0.90; 95% confidence interval, 0.89-0.92; >12: hazard ratio = 0.79; 95% confidence interval, 0.77-0.80), and addition of chemotherapy (hazard ratio = 0.69; 95% CI, 0.68-0.71). African American race (hazard ratio = 1.14; 95% confidence interval, 1.11-1.18) and increasing age correlated with an increased hazard risk (61-75 years: hazard ratio = 1.26; 95% confidence interval, 1.23-1.29; >or=76 years: hazard ratio = 2.15; 95% confidence interval, 2.09-2.21, compared with age <60 years). Survival in colon cancer is significantly impacted by patient's age, race, gender, and education status but not by income or area of residence.

Postoperative pulmonary embolism: timing, diagnosis, treatment, and outcomes.

BACKGROUND: Postoperative pulmonary embolism (PE) remains a major health concern. The purpose of our study was to evaluate our experience with postoperative PE. METHODS: We retrospectively reviewed the medical records of patients who had a postoperative PE at our institution. RESULTS: Our study included 115 patients. Prophylaxis was administered preoperatively in 31% of patients and postoperatively in 56% of patients. The diagnosis was obtained by computed tomography scan in 74 patients (64%), ventilation-perfusion scan in 24 patients (21%), angiogram in 8 patients (7%), and other modalities in 9 patients (8%). The time elapsed between surgery and the diagnosis of PE varied significantly by patient age (<40 y: 3 d, compared with 40-60 y: 11 d; P = .02). The majority of patients with PE were treated with anticoagulation (83%). Morbidity and mortality rates both were 9%. CONCLUSIONS: Age has a significant impact on the timing of postoperative PE, with the majority of cases being diagnosed with a computed tomography scan, and treated with anticoagulation.