An elderly man, who presented initially with clinical features of dementia, was found to havc an intracranial tension aerocele due to an underlying osteoma of the frontal sinus. Plain skull roentgenograms and computerized tomography did not reveal the osteoma, although a communication between thc frontal sinus and the aerocele was present. Surgical aspiration of the aerocele and excision of the osteoma produced an excellent clinical result.

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The uptake of quinidine by washed human red blood cells from isotonic buffer solution (pH 7.4) occurred rapidly and was proportional to the concentration of drug in buffer. A constant red cell/buffer partition ratio of 4.16+/‐0.15 s.e. mean was found. 2. Uptake from buffer solution was not affected by temperature or ouabain or by gassing with nitrogen or carbon monoxide and there was no evidence of saturability. Drug in red blood cells was associated largely with the cell contents (94.4+/‐1.5% s.e. mean) following partition. 3 Plasma reduced the uptake of quinidine so that a red cell/plasma partition ratio of 0.82+/‐ 0.09 s.e. mean was found. 4 Alteration of plasma binding by dilution of plasma with buffer showed that uptake was proportional to free drug concentration. 5 The possibility of red cell uptake of drug should be included in any considerations concerning pharmacokinetic aspects of drug action in the body.

Sodium valproate at a concentration of 300 mumol/l in whole blood, partitioned between the red blood cell and plasma to produce a red blood cell/plasma partition ratio of 0.20. Red blood cell uptake was proportional to percent free drug in plasma and uptake was maximal when plasma was replaced by buffer, producing a red blood cell/buffer ratio of 0.87. Reduction of plasma protein binding by plasma dilution, by increasing the total sodium valproate plasma concentration, or by renal or hepatic disease in 24 patients, caused a predictable rise in red blood cell uptake of drug. The red blood cell represented a relatively small compartment for free sodium valproate in blood, however uptake of the drug into this compartment increased considerably in states of reduced plasma protein binding. Because the concentration of drug in the red blood cell reflects free drug concentration in plasma, the red blood cell may serve as an indicator of free drug changes in blood.

SUMMARYTwo-hundred and eighty-nine patients who made a total of 323 presentations to the Royal Brisbane Hospital Accident and Emergency Department with a known or suspected oral drug overdose were reviewed. The majority of patients (76%) could be managed in a 24h Accident and Emergency observation unit. Activated charcoal given orally or via a nasogastric tube was the recommended method of preventing further absorption of an ingested drug. The use of syrup of ipecac was not encouraged and orogastric lavage was used in only specific situations. The morbidity and mortality of these patients when compared with other studies, was not adversely affected by this protocol which dramatically reduced the indications for the use of orogastric lavage and syrup of ipecac.