Objective: The purpose of this study was to evaluate the patients with acute amitriptyline poisoning and investigate predictive factors for the development of life-threatening complications. Methods: Demographics, clinical, laboratory, and electrocardiographic (ECG) findings of 250 patients were evaluated retrospectively. Predictive parameters for the development of serious complications were studied. Results: Median age of patients was 14.6 years, of which, 70% of patients were female and 66% were in pediatric age group. The most common pathological clinical finding and laboratory abnormality were alteration of consciousness and hyponatremia. The rate of convulsive seizure, arrhythmia, and respiratory depression were 17 (6.8%), 16 (6.4%), and 11 (4.4%), respectively. These complications were more seen in pediatric patients than adults (15.8% and 1.2%). The incidence of hyponatremia was more in pediatric patients and severe poisoning groups (38.8 and 53.4%, respectively). The levels of amitriptyline and nortriptyline were significantly higher in the group with complications than the group without complications ( p < 0.05). All adult patients were discharged with good prognosis. In pediatric age group, one patient was discharged with severe neurological sequelae and one patient died. QRS duration >100 ms, long corrected QT duration interval, and low Glasgow Coma Score (GCS) at admission were identified as independent risk factors for the development of life-threatening complications (odds ratio: 69.4, 1.9, and 1383, respectively; p < 0.05). Conclusion: Amitriptyline poisoning may be associated with life-threatening complications, especially in pediatric age group and in patients with hyponatremia. Low GCS, presence of hyponatremia, high serum drug levels, and pathological ECG findings on admission may be helpful in predicting the development of complications and poor prognosis.

Objective: The aim of the present study was to assess access site pain levels of patients undergoing coronary catheterization via transradial route. Methods: We performed a prospective and randomized study in which 408 patients underwent coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) via transradial approach (TRA) and 428 patients underwent CAG and/or PCI via transfemoral approach (TFA). Pain levels of patients were assessed with Visual Analog Scale (VAS) after catheterization and at 30 days. Student-t, Mann-Whitney U and chi-square tests were used for statistical analysis. Results: Patients in the TRA group showed higher VAS scores than those in TFA group after catheterization [CAG alone, 3 (2-5) vs. 1 (1-3), p<0.0001; PCI, 4 (2-6) vs. 2 (1-3), p<0.0001, respectively]. One month later, patients in TRA group also showed higher VAS scores than those in TFA group [CAG alone, 1 (0-1) vs. 0 (0-1), p<0.0001; PCI, 1 (0-2) vs. 0 (0-1), p<0.0001, respectively]. By the ROC analysis in TRA group, a level of BMI <24.3 kg/m 2 predicted unacceptable pain with a 87.3% sensitivity and 91.6% specificity [area under curve (AUC): 0.875, 95% CI: 0.839-0.906, p<0.0001], while a wrist circumference <16.7 cm predicted unacceptable pain with 84.6% sensitivity and 89.8% specificity (AUC: 0.900, 95% CI: 0.867-0.928, p<0.0001). Conclusion: The current study suggests that a radial approach for CAG and PCI in patients with a low BMI and small wrist circumference may cause more access site pain as compared with a femoral approach. (Anadolu Kardiyol Derg 2014; 14: 140-6)

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Difficulty in establishing a diagnosis of acute coronary syndrome (ACS) in the clinical setting has led researchers to investigate novel markers that show increased blood levels before the myocardial necrosis occurs. In ischemic conditions, some modifications occur in the amino acids located on the N-terminus of the human albumin molecule. Ischemia-modified albumin (IMA) is a marker formed after damage in the N-terminal region of albumin. The altered N-terminus can no longer bind transition metals, such as cobalt. The causes of the increases in IMA have been shown to be endothelial or extracellular hypoxia, acidosis, and free oxygen radicals. IMA, an early marker of ischemic disorders, is also a candidate marker for the detection of ACS. An assay measuring IMA might represent a promising marker for the identification of patients with myocardial ischemia. The aim of this study was to evaluate the clinical utility of IMA in the assessment of ACS as well as other medical disorders in light of the recent literature.