Serial ECG measurements at controlled plasma levels of nortriptyline in depressed children.

The authors investigated ECG measurements in 21 children with major depressive disorder treated with nortriptyline at plasma levels of 50-100 ng/ml. P-R and QRS intervals and heart rate measured at baseline and once a week during treatment remained within guidelines.

Practice patterns and opening pressure measurements using fluoroscopically guided lumbar puncture.

BACKGROUND AND PURPOSE: Evidenced-based protocols for fluoroscopically guided LP do not exist. This study analyzed the fluoroscopically guided LP techniques currently used by practicing neuroradiologists. MATERIALS AND METHODS: An anonymous Web-based survey was e-mailed to members of ASNR. The results were compiled and tabulated on a spreadsheet. RESULTS: A total of 577 neuroradiologists completed the survey. Most neuroradiologists perform fluoroscopically guided LPs with the patient in the prone position by using a 22-ga needle at the L2-L3 or L3-L4 intervertebral space. The OP measurement technique is quite variable. Only a minority of patients are rotated to the left LD position for OP measurement. Most neuroradiologists observe patients for 1-2 hours after the procedure and require strict bed rest. CONCLUSIONS: Most neuroradiologists have similar protocols for thecal sac puncture. Normative adult OP data exist only for the LD position, and the accuracy of prone OP measurements is not known. We found that the OP measurement technique is not consistent and a standard protocol is warranted.

Acute splenic sequestration in hemoglobin sickle O-Arab disease.

A white girl with sickle O-Arab disease (Hb S/O-Arab) had three separate episodes of acute splenic sequestration at 8, 12, and 15 months of age with hemoglobin levels falling to 3.9, 2.8, and 4.2 g/dl, respectively. Functional hyposplenism was suggested by the radionucleotide spleen scan. Following splenectomy her hemoglobin stabilized in the range of 0.7--8.5 g/dl. Life-threatening episodes of splenic sequestration, pneumococcal infections and osteomyelitis may occur in both Hb S/O-Arab and homozygous sickle cell diseases.

Nortriptyline pharmacokinetic parameters in depressed children and adolescents: preliminary data.

The pharmacokinetic parameters of nortriptyline in the pediatric age group following oral administration of a single dose of 25 or 50 mg were investigated from nortriptyline plasma level assays at 12, 18, 24, 36, and 48 hours postdose. Data were analyzed separately for the nine prepubertal and 11 postpubertal subjects, all of whom were diagnosed major depressive disorder. These data were compared with studies in the literature of nortriptyline pharmacokinetics from adult and geriatric normal and depressed populations. Similar to adults, the elimination of nortriptyline in children and adolescents is apparently first order kinetics with a logarithmically linear rate of disappearance. The prepubertals had a shorter mean half-life (17.6 +/- 3.7 hours) than some adult groups and twice a day dosage would, therefore, be more appropriate for many children. Although the mean half-life (27.1 +/- 17.1 hours) for the adolescent group suggested that once a day dosage would be sufficient, some adolescents would need twice a day dosage for optimum plasma level control because there was a wide range (14.1 to 76.2 hours). The almost twofold variation in half-life in prepubertals and fivefold variation in postpubertals were similar to differences in adult groups and emphasize the value of plasma level monitoring in the clinical use of nortriptyline.