Kazutoshi Kuboyama

Successful treatment of pulmonary contusion following chest trauma using poly‐2‐methoxyethyl acrylate, a biocompatible polymer surface coating for extracorporeal membrane oxygenation

We report a patient with life‐threatening lung contusion who was rescued using poly‐2‐methoxyethyl acrylate, a biocompatible polymer surface coating for extracorporeal membrane oxygenation, which enabled reduction of the dose of systemic anticoagulation to prevent circuit thrombosis.

Hyperpyrexia induced by a multiple antidepressants overdose.

A 23-year old male ingested an excessive amount of antidepressants that had been prescribed. Initially, he was hospitalized near his house. Subsequently, he was transferred to the emergency department (ED) in a university hospital, because of the difficulties in controlling his seizures. At the time of arrival in the ED, he was in cardiopulmonary arrest. His rectal temperature was 41.2°C (106.16°F). Resuscitation was unsuccessful. A number of empty packets of antidepressants were found in his house during the subsequent authorities’ investigation. At autopsy, no remarkable findings were observed except for severe pulmonary edema and congestion. No evidence of brain injury or infectious diseases such as meningitis, encephalitis or pneumonia was observed. Histological study of the skeletal muscle showed hypercontracted fiber appearing as ‘opaque fibres’ and multiple vacuolation (Figure 1). Drug screening testing using a TriageTM (Biosite Diagnostic Inc, San Diego, USA) panel was positive for benzodiazepines, barbiturates and tricyclic antidepressants, but negative for alcohol by gas chromatography. Figure 2 shows the chromatogram of femoral blood using a high performance liquid chromatography (HPLC) drug analysis system (Class VP system, Shimadzu, Kyoto Japan). Clomipramine, amoxapine, maprotiline, amitriptyline and milnacipran were confirmed by each retention time. The drug concentrations in the victim’s femoral blood and their fatal and therapeutic blood level are summarized in Table 1. Blood concentrations of clomipramine and amoxapine were at fatal levels, while the maprotiline and amitriptyline levels were toxic.2 Milnacipran, a newly developed serotonin-noradrenaline reuptake inhibitor, was found to be ten-fold higher than the therapeutic level.3 The positive benzodiazepines and barbiturates detected by the TriageTM screening