Primary tumors of the diaphragm.

have resulted from a delay in conduction from cell to cell in the ordinary ventricular myocardium, as in hyper-kalemia. Yet, the possibility of this being due to a selective action on the Purkinje fibers or in the Purkinje-myocardial junction cannot be excluded. Considering this observation and the available reports in the literature dealing with toxicity of imipramine and its sister compound, desipramine should be used with caution in patients with limited coronary reserve. Although significant rhythm abnormalities were not observed in our case, patients with desipramine over-dosage should be monitored in intensive coronary care units since arrhythmias are common cardiac complications. These arrhythmias may prove resistant to conventional therapy5 and it is therefore very important to prevent their occurrence. Since no antidote is available, attention should be concentrated on supportive measures as suggested in the literature for the treatment of imipra-mine overdosage:3'44 '4 1. Attempts at removing whatever drug is still in the stomach with lavage. 2. Adequate hydration with central venous pressure monitoring and caution to avoid heart failure. 3. Promoting osmotic diuresis with mannitol. 4. Good oxygenation, hoping to limit the possible subendocardial injury. 5. Isoproterenol may be used in some cases for its inotropic and chronotropic effects, and digitalis is advisable if failure supervenes.