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Barry JD et al Vasopressin treatment for cyclic antidepressant overdose J Emerg Med 2006 Jul;31(1):65 8 [PMID: 16798158] Boyer EW et al The serotonin syndrome N Engl J Med 2005 Mar 17;352(11):1112 20 [PMID: 15784664] Heard K et al A preliminary study of tricyclic antidepressant (TCA) ovine FAB for TCA toxicity Clin Toxicol (Phila) 2006;44(3):275 81 [PMID: 16749545] Montgomery SA Antidepressants and seizures: emphasis on newer agents and clinical implications Int J Clin Pract 2005 Dec;59(12):1435 40 [PMID: 16351676] Thanacoody HK et al Tricyclic antidepressant poisoning: cardiovascular toxicity Toxicol Rev 2005;24(3):205 14 [PMID: 16390222]

Figure 38 2 Cardiac arrhythmias resulting from tricyclic antidepressant overdose A: Delayed intraventricular conduction results in prolonged QRS interval (018 s) B and C: Supraventricular tachycardia with progressive widening of QRS complexes mimics ventricular tachycardia (Reproduced, with permission, from Benowitz NL, Goldschlager N Cardiac disturbances in the toxicologic patient In: Haddad LM, Winchester JF [editors], Clinical Management of Poisoning and Drug Overdose, 3rd edition Saunders/Elsevier, 1998) has also been described Prolongation of the QT interval has been reported with citalopram and venlafaxine Seizures and coma are common with severe intoxication Life-threatening hyperthermia may result from status epilepticus and anticholinergic-induced impairment of sweating Among newer agents, bupropion and venlafaxine have been associated with a greater risk of seizures The diagnosis should be suspected in any overdose patient with anticholinergic side effects, especially if there is widening of the QRS interval or seizures For intoxication by most tricyclic antidepressants, the QRS interval correlates with the severity of intoxication more reliably than the serum drug level Serotonin syndrome should be suspected if agitation, delirium, muscular hyperactivity, and fever develop in a patient taking serotonin reuptake inhibitors

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Observe patients for at least 6 hours, and admit all patients with evidence of anticholinergic effects (eg, delirium,

Specific information regarding emesis and chlorinated insecticides appears in CMDT Online at http://www accessmedicinecom

The clinical aspects of cancer prevention, diagnosis, primary treatment, management of complications, and paraneoplastic syndromes are the main focus of this chapter Further information may be obtained by calling the National Cancer Institute (NCI) Cancer Information Service at 1-8004CANCER or accessing NCI s comprehensive cancer information database Physician Data Query (PDQ) via the Internet at wwwcancergov/cancerinformation PDQ is also available on CD-ROM The CANCERLIT feature of Medline (PubMed) is a familiar resource for articles about cancer that can be accessed by author or by subject words A series of oncology practice guidelines compiled by a panel of United States experts and encompassing diagnosis and treatment of a wide variety of cancers as well as pain management is available free of charge at the National Comprehensive Cancer Network Web site (wwwnccnorg) and is updated yearly The American Society of Clinical Oncology has an information Web site for patients and their families (www PeopleLivingWithCancerorg) as well as patient guides on subjects such as follow-up care for breast and colorectal cancers, understanding tumor markers, treatment of nausea and vomiting, and advanced lung cancer Two Web sites provide updated data as well as review articles on advances in oncology; these sites allow the user to search for specific areas of interest as well: PeerView Press (info@peerviewpresscom) and Medscape Hematology-Oncology (http:// wwwmedscapecom/hematology-oncologyhome)

Cancer is the second most common cause of death in the United States The American Cancer Society estimates that almost 14 million new cases of invasive cancer will be diagnosed in the year 2007, with over 559,000 deaths Some type of invasive cancer will develop in slightly less than one of every two men and slightly more than one of every three women in the United States during their lifetime Based on the SEER 2005 database, the lifetime probability of developing cancer is about 46% for men and 38% for women and varies by race, and age Table 39 1 summarizes current US incidence and mortality figures for the ten leading types of cancer Women

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