Analysis of clinical risk factors of failed electrical cardioversion in patients with persistent atrial fibrillation or atrial flutter

Background@#Although rhythm control could be the best for symptomatic atrial fibrillation (AF), some patients fail to achieve sinus rhythm (SR). This study aimed to identify clinical risk factors of failed electrical cardioversion (ECV). @*Methods@#A total of 248 patients who received ECV for persistent AF or atrial flutter (AFL) were retrospectivelyreviewed. Patients were divided into three groups: Group 1 maintained SR for > 1 year, group 2 maintained SR ≤ 1 yearafter ECV, and group 3 failed ECV. SR maintenance was assessed using regular electrocardiography or Holter monitoring. @*Results@#Patients were divided into group 1 (73, 29%), group 2 (146, 59%), and group 3 (29, 12%). The mean ageof patients was 60 ± 10 years, and 197 (79%) were male. Age, sex, and baseline characteristics were similar amonggroups. However, increased cardiac size, digoxin use, heart failure (HF), and decreased left ventricular ejection frac‑ tion (LVEF) were more common in group 3. Univariate analysis of clinical risk factors for failed ECV was increasedcardiac size [hazard ratio (HR) 2.14 (95% confidence interval [CI], 1.06–4.34, p = 0.030)], digoxin use [HR 2.66 (95% CI, 1.15–6.14), p = 0.027], HF [HR 2.60 (95% CI, 1.32–5.09), p = 0.005], LVEF < 40% [HR 3.45 (95% CI, 1.00–11.85), p = 0.038], and decreased LVEF [HR 2.49 (95% CI, 1.18–5.25), p = 0.012]. Among them, HF showed clinical significance only by multivariate analysis [HR 3.01 (95% CI, 1.13–7.99), p = 0.027]. @*Conclusions@#Increased cardiac size, digoxin use, HF, LVEF < 40%, and decreased LVEF were related to failed ECV for persistent AF or AFL. Among these, HF was the most important risk factor. Further multi-center studies including greater number of participants are planned.

Enhanced alcohol degradation and hepatic protective effects of an Acetobacter Pasteurianus-derived product, CureZyme-ACE, in an acute intoxication rat model / 한국실험동물학회지

Excessive alcohol consumption induces acute intoxication and various hepatic diseases. In this study, we investigated the effect of the CureZyme-ACE (CA), Acetobacter Pasteurianus (AP)-derived product, in acute intoxication rats. The ethanol and acetaldehyde levels of serum were lower in rats treated with CA than those who only treated ethanol. The activities of alcohol dehydrogenase and acetaldehyde dehydrogenase also recovered faster in the CA group than only-ethanol group. The transaminase levels (AST, ALT) in the CA group were significantly lower than only-ethanol group. In addition, Hepatic histological analyses and stomach wall were demonstrated that the CA-treated group recovered faster than only-ethanol group. With regard to most characteristics, we found that CA had dose-dependent effects. At high concentrations of CA, there were no differences in the tested parameters compared to those of normal rats. These findings indicate that CA reduces the serum alcohol concentration and some of the hepatic damage caused by alcohol intoxication.

Listeria monocytogenes Bacteremia in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

We report a 43-year old woman of Listeria monocytogenes bacteremia associated with systemic lupus erythematosus (SLE). She had been treated with glucocorticoid pulse therapies and a cyclophosphamide pulse therapy for relapsed lupus nephritis class IV. After the immunosuppressive treatment, she complained of fever, vomiting, diarrhea, and abdominal pain. Diffuse edematous thickening of bowel wall was seen on abdominal CT scan and Listeria monocytogenes was identified on blood culture study. After antibiotic therapy that lasted for more than 4 weeks, her presenting symptoms were resolved and no more Listeria monocytogenes was identified on follow-up culture studies. Infection with Listeria monocytogenes, a rare food-borne illness, can be life-threatening with high fatality rates and is known to occur more frequently in immunocompromised patients, including those receiving high-dose glucocorticoid or immunosuppressive therapy for collagen vascular disease. In Korea, a case of Listeria meningitis was reported, but a case of bacteremia caused by Listeria monocytogenes enteritis has never been reported in SLE patients. Thus, we report a case of Listeria monocytogenes bacteremia that occurred due to food poisoning after aggressive immunosuppressive treatment in a patient with SLE.

Multiple Cavitary Pulmonary Metastases from Cholangiocarcinoma / 결핵

Because a cavitary pulmonary metastasis is rare, it may not be readily identified. However, various types of cancers can metastasize to the lung in the form of cavities. We report a case of a multiple cavitary metastases to the lung from a cholangiocarcinoma in a 60-year-old man. He complained of generalized weakness and a poor oral intake for 2 months. The plain chest radiography and the chest computed tomography showed multiple small thick-walled cavities and nodules the both lungs. A bronchoscopic examination revealed a focal irregularly elevated surface of the mucosa at the orifice of the superior segment of the right lower lobe and the biopsy demonstrated an infiltrative metastatic adenocarcinoma. The abdomen-pelvis computed tomography showed an ill-marginated and irregularly low-dense area in the right lobe of the liver and a diffuse dilatation of the peripheral intrahepatic bile ducts. The esophagogastroscopy and colonoscopy showed no abnormal findings. It was concluded that the cholangiocarcinoma of the liver metastasized to the lung in the form of cavities. Thereafter, the patient underwent six cycles of the systemic chemotherapy with gemcitabine and cisplatin, and the follow-up imaging studies showed a partial response.

A Case of Hypereosinophilic Syndrome Presenting with Bilateral Pleural Effusions & Recurrent Bilateral Pneumothoraces / 결핵및호흡기질환

Idiopathic hypereosinophilic syndrome (HES) is a disorder characterized by prolonged eosinophilia without an identifiable cause and eosinophil related tissue damage in multiple organs including heart, lung, skin, gastrointestinal tract, liver, and the nervous systems. Pulmonary involvement occurs in about 40% of HES cases, but pleural effusion due to pleuritis and bilateral pneumothoraces are very rare manifestations. We report a case of hypereosinophilic syndrome presented with bilateral pleural effusions and recurrent bilateral pneumothoraces in a 44 year-old male with brief review of the literature.

Comparison of Arterial Blood Pressure Measured with an Aid of Non - invasive and Invasive Methods / 대한마취과학회지

The frequent measurement and recording of arterial blood pressure are fundamental parts of patient monitoring in the intensive care unit and the operating room. Two major categories of techniques for measuring arterial blood pressures, non-invasive(indirect) and invasive (direct) methods are currently available. But many physicians often have an experience to recognize that there are some variances in arterial blood pressure data depending on the measuring techniques or personnels. In view of these points, we carried out this study to examine whether these variances of arterial blood pressures measured by Riva-Rocci cuff and Korotkoff sound method (indirect l), automatic non-invasive method (indirect 2) and arterial cannulation method (direct) and those measured by nurse and student nurse are statistically significant or not in 14 patients. The results were as follows. l) In contrast to statistically non-significant variances of diastolic and mean blood pressures among indirect 1, 2 and direct method measured by nurse, there was significant variance of systolic blood pressures between indirect l and direct method, 120+/-13 torr and 129+/-15 torr, retrospectively (p<0.05), 2) There were no statistically significant variances of systolic, diastolic and mean blood pres- sure between two indirect methods measured by nurse. 3) In contrast to non-significant variances among systolic blood pressure measured with an aid of indirect 1, 2 and direct method by student nurse, diastolic blood pressure by indirect 1, 88+/-l4 torr was significantly elevated as compared with those by indirect 2 and direct method, 79+/-l3 torr and 81+/-13 torr, retrospectively (p<0.05). 4) there was significant variance of mean blood pressures measured by student nurese between indirect 1 and 2 methods, l0113 torr and 94+/-13 torr, retrospectively (p<0.05). 5) there were significant variances between systolic, diastolic and mean blood pressures of 120+/-13 torr, 80+/-13 torr and 93+/-12 torr measured by nurse and those of l28+/-14 torr, 88+/-14 torr and 101+/-13 torr measured by student nurse, retrospectively (p<0.05).

Subarachnoid Hemorrhage during General Anesthesia for Vaginal Hysterectomy / 대한마취과학회지

Intracranial hemorrhage is one of the fatal complications related to general anesthesia, it can occur in patients with intracranial aneurysm, hypertension, vascular malformation, malignancy and blood dyscrasia. We have experienced a case of death from massive surbarachonoid hemorrhage during general anesthesia. A 38 Years old female patient who had no abnormality in past history, physical examination and laboratory finding preoperatively, admitted for vaginal hysterectomy becauae of secondary uterine prolapse. Anesthesia was performed under tracheal intubation with Halothane-Enflurane, O2,N2O and with induction by pentothal sodium and succinylcholine. After operation, the patient showed delayed recovery from anesthesia and both pupils were dilated without light reflex. In optic fundoscopic view, fundus was furfilled with red-pinkish blood and CSF in spinal tapping was dark bloody colored. Brain C-T showed generalized brain edema and hemorrhage density in sylvian cistern, basal cistern, lateral ventricle. Autopsy finding revealed massive subarachnoidal hemorrhage but not disclosed the site of ruptured intracranial aneurysm. Authors report this case of death from subarachnoid hemorrhage for warning of possible victim during general anesthesia for referencial review.