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BACKGROUND: The pharmacological cardioversion of recent-onset atrial fibrillation (AF) is a challenge for the clinician. The aim of the study was to compare the efficacy, the safety, and the overall cost of intravenous (iv) administration of vernakalant, which is a relatively new atrial-selective antiarrhythmic agent, versus ibutilide, in cardioversion of recent-onset AF. METHODS: We enrolled in this study 78 patients (56 men, 22 women; mean age 63.72 ± 6.67 years) who presented with recent-onset AF. Cardioversion was attempted in 36 patients (group A: 24 men, 12 women; mean age 62.44 ± 7.24 years) by iv administration of vernakalant (3 mg/kg over 10 min and if needed after 15 min, a second dose 2 mg/kg over 10 min) while in 42 patients (group B: 32 men, 10 women; mean age 64.81 ± 6 years) iv ibutilide was administered (1 mg over 10 min and if needed after 10 min, a second dose 1 mg over 10 min). RESULTS: AF was successfully converted in 52.78 % of (n =19) patients of group A vs 52.38 % of (n =22) patients of group B (p =0.58), with an average time of conversion 11.8 ± 4.3 min for group A patients vs 33.9 ± 20.25 min for group B patients (p <0.0001). The average length of hospital stay for patients of group A was 17.64 ± 15.96 hours vs 41.09 ± 17.6 hours for patients of Group B (p <0.0001). In one patient of group A, the administration of vernakalant was discontinued due to hypotension while two other patients reported dysgeusia during their hospitalization. In three patients of group B, the administration of ibutilide was discontinued due to development of nonsustained ventricular tachycardia, which resolved with discontinuation of the drug. The cost of administered drugs was estimated at 488.22 ± 170.34 for patients of group A vs 142.43 ± 54.45 for patients of group B (p <0.0001), however, hospitalization costs were significantly lower in patients of group A (258.5 8± 124.73 over 414.43 ± 100.32; p =0.002). CONCLUSION: There was no significant difference in the efficiency of converting recent-onset AF between vernakalant and ibutilide. Although vernakalant is an expensive drug, we recorded fewer side effects and more rapid restoration, which reduced the overall cost of hospitalization of these patients. HIPPOKRATIA 2017, 21(2): 67-73.
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INTRODUCTION: Anaphylactic shock and pulmonary edema are unusual but life-threatening adverse reactions to drugs. We encountered a case of serious anaphylactic shock and acute pulmonary edema caused by a single oral intake of acetazolamide, a frequently used medication by several medical specialties especially in ophthalmology. CASE PRESENTATION: An 80-year-old female was admitted to our emergency Coronary Unit presenting symptoms and signs of shock with acute pulmonary edema. Patient was hospitalised at the Opthalmological Department with intention to undergo cataract surgery. Approximately, four hours before operation, half a tablet of acetazolamide 250 mg was given, in order to control her pre-operative intraocular pressure. Half an hour later, she complained of nausea, became cyanotic, and suffered acute respiratory failure with characteristic massive pulmonary edema. Ventilatory support was initiated and O2 saturation increased to 89%. She was administered 2 ampoules of intravenously furosemide. The blood chemistry panel was normal, as well as myocardial cytolysis tests. Chest radiograph showed enlarged cardiothoracic index, ill-defined vessels, peribronchial cuffing, alveolar edema. An echocardiogram showed normal atria and ventricles, normal systolic function, and excluded pulmonary hypertension. Furosemide (40 mg/IV, S: 1x3) and oxygen (8 Lt/min) were administered for the following 24 hours. Clinical improvement was seen and the O2 saturation was normalized. ECG controls were normal. The patient experienced a full recovery and was discharged 3 days later. CONCLUSION: The relationship between anaphylactic shock with acute pulmonary edema and acetazolamide seems highly probable in this case, considering the short time between drug assumption and onset of symptoms (about 30 minutes) and the absence of previous diseases to which symptoms could be related. The patient was not previously treated with acetazolamide. Nowadays, the clinical use of acetazolamide is very limited. Its principal uses are in the preoperative treatment of closed angle glaucoma and continuative therapy of open angle glaucoma.
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INTRODUCTION: Perianal abcess and fistula-in-ano are particular when happening in infants of less than 1 year of age. A congenital abnormality of crypts of Morgagni may be at the origin of the disease. There is no evidence for predisposing condition at this age. CASE REPORT: A 7-week-old boy had a painful swollen perianal lesion suggesting the presence of perianal abcess. Biological tests did not show any neutropenia nor inflammatory syndrome. The infant was admitted to the surgical center to undergo a perianal abcess drainage. During the intervention, no fistula was found. No recurrence was observed. DISCUSSION: Perianal abcess and/or fistula-in-ano are relatively common conditions in infants of less than 1 year of age. This disease is suspected to originate from anal cryptitis, which will later form a perianal abcess. Androgen excess during the foetal stage could be the cause of the formation of abnormal crypts of Morgagni, which encourages cryptitis and abcess formation. In childhood some predisposing factors can exist, as immunodeficiency or colopathy. On the opposite, a predisposing condition is rare in infancy. Twenty-eight to 85 per cent of infants with perianal abcess may progress to form a fistula. The usual treatment of perianal abcess is incision and drainage; it may be completed by fistulotomy or fistulectomy. The antibiotherapy is not systematic. The identification of the corresponding crypt may be important to avoid recurrence. On the opposite, a recent prospective study proposes a non operative management of perianal abcess and fistula-in-ano in healthy infants.
