Spontaneous Rupture of the Internal Thoracic Artery Causing a Mediastinal Hematoma in a Patient with Alcoholic Liver Cirrhosis: A Case Report.

Spontaneous arterial bleeding is uncommon, and a mediastinal hematoma caused by spontaneous rupture of the internal thoracic artery has not been reported previously. Patients with liver cirrhosis or heavy alcohol consumption have a higher risk of hemorrhage than those without cirrhosis or excessive alcohol consumption. We present the case of a 39-year-old female with a history of alcoholic liver cirrhosis, who presented with a large mediastinal hematoma attributable to spontaneous rupture of the internal thoracic artery.

Endovascular Management of Iatrogenic Vertebral Artery Pseudoaneurysm: A Case Report.

Iatrogenic injury of the vertebral artery during cervical spine surgery though uncommon is critical. With advances in interventional endovascular techniques, the therapeutic approach for vertebral artery injuries has changed. Nonetheless, an established strategy for their management is lacking. We report a case of pseudoaneurysm due to vertebral artery injury, during cervical spine surgery for a tumor, that was treated successfully with endovascular coiling in a plug-and-patch fashion after triple stenting failed.

Assessment of coronary spasms with transluminal attenuation gradient in coronary computed tomography angiography.

PURPOSE: To evaluate the imaging features of coronary spasm, including transluminal attenuation gradient (TAG) on coronary computed tomography angiography (CCTA), in patients with vasospastic angina (VA). METHODS: A total of 43 patients with a high clinical likelihood of VA were included in the study. All the subjects underwent double CCTA acquisition: CCTA without a vasodilator ('baseline CT') and CCTA during continuous intravenous nitrate infusion ('IV nitrate CT'). A catheterized ergonovine provocation test was used to determine true VA patients. Coronary spasm is classified into focal- and diffuse-types according to morphological differences. We measured TAG and contrast enhancement of the proximal ostium (ProxHU) of each coronary artery for both the baseline and IV nitrate CT. RESULTS: Twenty-four patients (55.8%) showed positive results of coronary vasospasm on the provocation test. Thirty-eight vessels showed coronary spasms (29.5%): Focal-type in nine vessels (24%), and diffuse-type in 29 (76%). In the baseline CT, LCX showed significantly lower (steeper) TAG in spasm(+) vessels than in spasm(-) vessels, while LAD and RCA showed no significant differences in TAG. The ProxHU of LAD showed significantly lower values in spasm(+) vessels than in spasm(-) vessels, while the other vessels did not show significant differences in ProxHU. For IV nitrate CT, there were no significant differences in either the TAG and ProxHU between spasm(+) and (-) vessels for all the three vessel types. In subgroup analysis for spasm(+) vessels, diffuse spasms showed significantly lower TAG than focal spasms, while the ProxHU did not differ between the two types of spasm. CONCLUSIONS: A relatively large percentage of coronary spasms present as diffuse type, and the TAG values significantly differed according to the morphological type of the coronary spasm.

The efficacy and safety of combined microneedle fractional radiofrequency and sublative fractional radiofrequency for acne scars in Asian skin.

BACKGROUND: Microneedle fractional radiofrequency has been reported to be effective for improving wrinkles, enlarged pores and various scars. Sublative fractional radiofrequency has been shown to induce both fractional ablation of epidermis and upper dermal remodelling, which had rejuvenation effects in photoaged skin. Both modalities may have the potential synergy to improve acne scars. OBJECTIVE: To evaluate the efficacy and safety of combined microneedle and sublative fractional radiofrequency for acne scars in Asian skin. METHODS: Twenty subjects comprised 11 males and 9 females (mean age 23.65 ± 2.94, skin phototype III-IV) with moderate to severe acne scars. The subjects received three consecutive combined microneedle and sublative fractional radiofrequency at 4-week intervals over 12 weeks. Both blinded dermatologists and subjects assessed the clinical improvement based on the standardized photography and questionnaires, respectively. The quartile grading scale was utilized and defined as follows: grade 1, 0-25% improvement; grade 2, 26-50% improvement; grade 3, 51-75% improvement and grade 4, 76-100% improvement. RESULTS: All 20 subjects were assessed to have grade 2 or more clinical improvement by physicians; four (20%) had grade 4, 10 (50%) had grade 3, and six (30%) had grade 2 improvement. The subjects' grading also showed a good concordance as indicated by Kappa index of 0.695. The mean duration of post-therapy crusting was 5.2 days and post-therapy erythema lasted 2.5 days. CONCLUSION: Combined microneedle and sublative fractional radiofrequency can have a positive therapeutic effect with no serious complications and may provide a new therapeutic approach on acne scars in Asians.

The efficacy and safety of intense focused ultrasound in the treatment of enlarged facial pores in Asian skin.

BACKGROUND: Intense focused ultrasound (IFUS) has been used successfully for skin tightening. OBJECTIVE: To investigate the efficacy of IFUS in treating enlarged pores and to evaluate changes in skin elasticity and sebum production following IFUS. MATERIALS AND METHODS: Twenty-two subjects with enlarged pores were randomized to receive a single treatment with IFUS using 1.5-mm transducer on one side of the face, and 3.0-mm transducer on the other. OBJECTIVE clinical assessments were made by blinded photographic evaluation. Subjective satisfaction and adverse effects were evaluated. Measurements of elasticity and sebum were performed at baseline, 3 and 6 weeks post-treatment. RESULTS: Physicians' evaluation showed clinical pore improvements in 86% and 91% of the IFUS-treated sites using 1.5-mm and 3.0-mm transducer, respectively. The mean improvement scores were 1.7 and 1.9 for 1.5-mm and 3.0-mm transducer, respectively, with no statistical differences. Cutometer measurement demonstrated a significant improvement in skin elasticity. Sebum level showed a reduction without statistical significance. There was a positive correlation between improvement in elasticity and pore improvement grades. All treatments were well tolerated without significant side effects. CONCLUSION: IFUS using 1.5-mm or 3.0-mm transducer was safe and effective for reducing enlarged pores in Asian skin with an improvement in skin elasticity.