ABSTRACT
A 75-year-old man with chronic cholangitis and a common bile duct stone that was not previously identified was admitted for right upper quadrant pain. Acute cholecystitis with cholangitis was suspected on abdominal computed tomography (CT); therefore, endoscopic retrograde cholangiopancreatography with endonasal biliary drainage was performed. On admission day 5, hemobilia with rupture of two intrahepatic artery pseudoaneurysms was observed on follow-up abdominal CT. Coil embolization of the pseudoaneurysms was conducted using percutaneous transhepatic biliary drainage. After several days, intrahepatic artery pseudoaneurysm rupture recurred and coil embolization through a percutaneous transhepatic biliary drainage tract was conducted after failure of embolization via the hepatic artery due to previous coiling. After the second coil embolization, a common bile duct stone was removed, and the patient presented no complications during 4 months of follow-up. We report a case of intrahepatic artery pseudoaneurysm rupture without prior history of intervention involving the hepatobiliary system that was successfully managed using coil embolization through percutaneous transhepatic biliary drainage.
Subject(s)
Aged , Humans , Aneurysm, False , Arteries , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis , Cholecystitis, Acute , Common Bile Duct , Drainage , Embolization, Therapeutic , Follow-Up Studies , Hemobilia , Hepatic Artery , Rupture , Tomography, X-Ray ComputedABSTRACT
A 75-year-old man with chronic cholangitis and a common bile duct stone that was not previously identified was admitted for right upper quadrant pain. Acute cholecystitis with cholangitis was suspected on abdominal computed tomography (CT); therefore, endoscopic retrograde cholangiopancreatography with endonasal biliary drainage was performed. On admission day 5, hemobilia with rupture of two intrahepatic artery pseudoaneurysms was observed on follow-up abdominal CT. Coil embolization of the pseudoaneurysms was conducted using percutaneous transhepatic biliary drainage. After several days, intrahepatic artery pseudoaneurysm rupture recurred and coil embolization through a percutaneous transhepatic biliary drainage tract was conducted after failure of embolization via the hepatic artery due to previous coiling. After the second coil embolization, a common bile duct stone was removed, and the patient presented no complications during 4 months of follow-up. We report a case of intrahepatic artery pseudoaneurysm rupture without prior history of intervention involving the hepatobiliary system that was successfully managed using coil embolization through percutaneous transhepatic biliary drainage.
ABSTRACT
BACKGROUND: Rosacea is characterized by erythema of the central face that persists for several months or longer. Reports of the histological changes in rosacea are scarce, and few attempts have been made to correlate such changes with clinical findings and pathophysiology. OBJECTIVE: This study aimed to elucidate the clinical manifestations of rosacea and investigate its histological features. METHODS: We performed a retrospective analysis of 278 patients with histologically confirmed rosacea who visited the Department of Dermatology at the Catholic Medical Center between January 2008 and May 2013. Clinical subtypes, disease severity, and precipitating factors were evaluated. In 115 randomly selected patients, histopathological features were evaluated as well. RESULTS: The ratio of males to females was 1:1.8. The age distribution showed a peak incidence in the fifth decade. The most common subtype was papulopustular rosacea (52.9%) followed by erythematotelangiectatic rosacea (34.9%), ocular rosacea (4.0%), and phymatous rosacea (2.9%). Granulomatous rosacea accounted for 5.4% of rosacea cases. Precipitating factors included hot weather (54.7%), stress (51.8%), sun exposure (37.4%), alcohol (37.4%), and hot baths (33.1%). Histological analysis of skin biopsies from 115 patients revealed solar elastosis in 62 patients (53.9%) and telangiectasia in 85 patients (73.9%). CONCLUSION: In this study, Korean rosacea patients were predominantly female with a peak age in the fifth decade and the majority suffered from the papulopustular and erythematotelangiectatic types of rosacea. Histological observations pertaining to each rosacea type were also discussed.
Subject(s)
Female , Humans , Male , Age Distribution , Baths , Biopsy , Dermatology , Erythema , Incidence , Korea , Precipitating Factors , Retrospective Studies , Rosacea , Skin , Solar System , Telangiectasis , WeatherABSTRACT
BACKGROUND: Beau's lines are transverse furrows of the nail plates that can be caused by various conditions. Because the clinical manifestations of Beau's lines tend to depend on its causes, the clinical manifestations may provide diagnostic clues of causative or underlying diseases. OBJECTIVE: This study is conducted to provide a better understanding of Beau's lines and to give dermatologists diagnostic clues from assessment of its morphological patterns. METHODS: In order to investigate the clinical characteristics and patterns of Beau's lines according to its clinical manifestations, a retrospective study was being performed. A total of 150 patients with Beau's lines who visited the nails clinic of our hospital from January 1, 2006, to September 30, 2010, were included. RESULTS: The group of patients with Beau's lines consisted of 78 males (52%) and 72 females (48%). The onset age ranged from 1 to 82 years old. The most frequently involved fingernail was the right thumb nail. In this study, causes of Beau's lines were grouped into eight categories: idiopathic, traumatic, nail/skin disease, systemic illness, bone marrow transplantation, chemotherapy, nail infection, and others. Idiopathic cause was observed the most frequently. The pattern of Beau's lines was symbolized in each patient and was depicted in a row according to order of frequency. The pattern of N2B2L1D1M2 (Numerous/Multiple/Incomplete/Deep/Broad) was observed overall as the most frequently. The most common pattern in the nail/skin diseases category was N2B1L1D1M2 (Numerous/Single/Incomplete/Deep/Broad). In the traumatic group, N1B2L1D1M2 (Confined/Multiple/Incomplete/Deep/Broad) was the most frequently observed pattern. CONCLUSION: This study explored the clinical manifestations of Beau's lines. In some categories of causes, the morphological patterns showed a tendency to converge. Thus, the morphological patterns can provide certain diagnostic information.