Efficacy of Sotalol and Amiodarone for Atrial Fibrillation

BACKGROUND AND OBJECTIVES: Atrial fibrillation(AF) is the most frequently encountered arrhythmia in clinical practice. Pharmacologic therapy has been advocated for both immediate restoration of sinus rhythm and prevention of recurrent AF. Because conventional antiarrhythmic therapy is often ineffective in maintaining sinus rhythm or is associated with adverse side effects in patients with AF, recent interest has focused on the use of class III antiarrhythmic agents. This study investigated the efficacy and safety of sotalol and amiodarone for conversion of chronic AF and prevention of recurrent AF. MATERIALS AND METHOD: Thirty six patients with AF were firstly received sotalol by prospective study protocol. The patients were classified as having paroxysmal AF(PAF, N=2) or chronic AF(CAF, N=4) based on AF pattern. If the patients with CAF did not convert to sinus rhythm or the patients with PAF recurred in AF, the patients were received second agents(amiodarone). Patients were followed up for one year. RESULTS: Among the 12 patients with PAF receiving sotalol, 10(83.3%) patients remained in normal sinus rhythm for average 9.4+/-3.6 months. Sotalol was replaced by amiodarone in the remaing 2 patients with arrhythmia recurrence and 1 of the 2 patients remained in sinus rhythm during the follow-up period. In the case of 24 patients with CAF, conversion to sinus rhythm was achieved in 5(20.8%) patients with sotalol. Among the patients with CAF who were not respond to sotalol, 17 patients received amiodarone subsquently and 3 patients successfully converted to sinus rhythm. There were no proarrhythmic effects related to both agents during the study period. CONCLUSION: Both sotalol and amiodarone appear to be less effective in the termination of CAF, but sequential use of these two agents seem to be very effective for the prevention of recurrence of PAF.

A case of primary T cell lymphoma of the liver presented as FUO / 대한내과학회지

Primary non-Hodgkin's lymphoma of the liver, an organ normally devoid of a native lymphoid tissue, is very rare. We report a case of primary hepatic T-cell lymphoma in a 18-year-old girl, with review of literature. The pateint admitted with fever for 5 months. The ultrasonography revealed a 10 x 7 cm sized mass in the left lobe of the liver. On abdominal CT, the mass was poorly enhancing and low attenuated. On MRI, the signal intensity of the mass was low in T1 weighted image, heterogeneously high in T2 weighted image, and peripherally enhanced in contrast enhancing T1 weighted image. The biopsy specimen obtained by laparatomy showed anaplastic tumor. The malignant cells were positive for T-cell lineage (CD3, CD44, CD45RO). There was no evidence of the lymphoma in other regions. The patient was treated with CHOP (cyclophosphamide, adriamycin, vincristine and prednisolone) chemotherapy without objective response. The patient died of sudden cardiogenic shock.

Double Primary Gastrointestinal Stromal Tumor Associated with Upper Gastrointestinal Bleeding / 대한소화기내시경학회지

The terms "gastrointestinal stromal tumor" (GIST) have been applied to mesenchymal tumos that represent neither typical leiomyoma nor schwannoma. The majority of GISTs are Located in the stomach and small intestine, and only 4% of GISTs are found in duodenum. The most important characteristic is their indolent, slow-growing nature, rendering the most common definitions of malignancy invalid and inapplicable. Clinical and pathological criteria to differentiate benign from malignant GISTs are not well established. Tumor size and mitoic activity are commonly considered as important features, allowing for the prediction of biological behaviour and outcome. The case of a 87-year-old male patient who was presented with melena and acute anemia is herein reported. Esophagogastroduodenoscopy and computed tomography of the abdomen revealed two submucosal tumors in the stomach and duodenum. Histological and immunohistochemical studies on the surgical resection specimen revealed a gastrointestinal stromal tumor of an uncommiteed type, with no evidence of increased mitotic activity. The patient was treated with local excision of the tumors and is now in a favorable state.

A Case of pulmonary lymphangioleiomyomatosis developed in tuberous sclerosis with renal angiomyolipoma / 결핵

Tuberous sclerosis is a rare hereditary anomaly of variable penetrance characterized by mental retardation, epilepsy, and adenoma sebaceum. Pulmonary involvement is uncommon, but, when involve by tuberous sclerosis, it shows characteristic reticulonodular infiltration and cystic changes. Lymphangioleiomyomatosis is a rare disease of unknown cause that affects women of reproductive age. It is characterized by progressive proliferation of smooth muscle in the lung. We experienced one case of pulmonary lymphangioleiomyomatosis associated with tuberous sclerosis in a 26-year-old female patient. This case is reported with a brief of the literature.

The Difference of Autonomic Dysfunction according to the Absence or Presence of Nephropathy in NIDDM Patients / 대한신장학회잡지

In order to assess the difference of autonomic dysfunction according to the absence or presence of nephropathy in patients with NIDDM, tests for cardiovascular autonomic function were performed in 23 NIDDM patients without nephropathy(M : F 14 : 9, mean age 50+/- 8) and in 21 patients with nephropathy (M : F 13 : 8, mean age 57+/-12). Tests for cardiovascular autonomic function included the R-R interval changes in response to respiration, Valsalva maneuver, and lying-standing, the blood pressure changes in response to lying-standing and sustained handgrip exercise. The prevalence of autonomic dysfunction was different between the patients without and with nephropathy(69.6% vs 85.7%). For patients without symptoms suggesting autonomic neuropathy, the significant differences were found in the change of R-R interval in response to respiration(22.16+/-21.30 vs 11.73+/-10.83; p=0.0390), in the change of lying-standing blood pressure(10.63+/-9.70 vs 22.00+/-13.67; p= 0.0044) and in the change of blood pressure during handgrip exercise(16.89+/-10.28 vs 8.40+/-7.24; p=0.0065). These results suggested that autonomic neuropathy may occur more frequently in patients with diabetic nephropathy than diabetes mellitus without neuropathy.