RESUMO
Coronary artery perforation (CAP) is a rare entity that is often fatal. The mortality rates reported as high as up to 21% hence prompt diagnosis, intervention, and treatment are paramount to survival for such patients. Several factors may predispose a patient to coronary artery intervention including chronic total occlusion, severe calcification and tortuosity, aggressive use of oversized balloons and stents, and use of athero-ablative devices. Therefore, it is significant to have an insight related to it as despite being rare, it is one of the most feared complications of percutaneous coronary intervention (PCI). Method: We conducted a retrospective study of the patients who have undergone PCI at our institution from January 2015 to December 2021. During this duration, all the patients who had developed CAP based on angiographic review during the PCI were selected. The demographic, clinical, angiographic, procedure-related features, management of the CAP, and in-hospital and follow-up outcomes were gathered. Result: Thirty-five thousand fifty-nine patients underwent PCI among which, only 93 (0.26%) patients were complicated with (CAP. Fifty-eight (62.4%) patients were in the 50-70 years age range. The most common vessel involved was the left anterior descending (36.5%) followed by the right coronary artery (32.3%). The angiographic calcification was present in 51.6% of patients, significant tortuosity greater than 90° was seen in 48.4% of patients, chronic total occlusion was observed in 42% of patients and In-stent restenosis was found in 8.6% patients. The highest mortality of four patients was seen in the CAP involving the right coronary artery. Conclusion: Mostly the CAP involves large vessel perforations however both, the distal and large vessel perforations are related to the increased incidence of adverse clinical results which indicates the significance of the prevention and early identification and treatment of the perforation.
RESUMO
Introduction Alopecia is a common dermatological condition with varied etiologies based on age, gender and geographic location. Non-cicatricial (non-scarring) alopecia is more common but often not biopsied. Alternatively, primary cicatricial (scarring) alopecia is diagnostically more challenging and more commonly biopsied to determine the etiology. In this study, we evaluated the clinicopathological characteristics of alopecia in our population. Methods We conducted a retrospective study at the Department of Histopathology, Liaquat National Hospital and Medical College, Pakistan. A total of 104 patients were enrolled in the study who underwent scalp biopsy for alopecia over a period of 11 years. Clinical data were obtained from clinical referral forms, which included age, sex of the patients and duration of the lesions. Three hematoxylin and eosin-stained tissue sections, along with periodic acid-Schiff (PAS), PAS with diastase and collagen stains were examined, and histopathological diagnosis was rendered. Results Our study demonstrated that alopecia was more prevalent among females, accounting for 73.1% of cases. Most of the patients belonged to the age group of <35 years (53.8%). The type of alopecia in 88.5% of the cases was scarring, while there were 11.5% cases of non-scarring alopecia. The most common diagnoses were discoid lupus erythematosus (DLE) (23.1%) and pseudopelade of Brocq (PB) (23.1%), followed by lichen planopilaris (LPP) (15.4%). A significant association was noted between the histological features and the diagnosis, as epidermal atrophy was the most common histological feature in most cases of DLE, followed by periadnexal infiltrates, lymphocytic infiltrates, follicular plugging and basement membrane thickening. In LPP, the most common histological features were perifollicular infiltrates and fibrosis. In PB, the frequently recurring histological features in most cases were the loss of sebaceous glands, dermal fibrosis and epidermal thinning. Conclusion In this study, we demonstrated the key role of skin punch biopsy and histology in determining the accurate etiology of scarring alopecia. We found discoid lupus erythematosus and pseudopelade of Brocq to be the most common causes of scarring alopecia, followed by lichen planopilaris.
