Hemobilia with acute pancreatitis secondary to biliary tract infection

Hemobilia is a rare medical condition with variety of etiologies.Among them,two in thirds are iatrogenic.Hemobilia combined with acute pancreatitis is unusual.Herein we reported a case of hemobilia with acute pancreatitis secondary to biliary tract infection.A 76-year-old male patient had intermittent abdominal pain for 2 days,which was aggravated for 1 day.He was admitted to the Emergency Department on August 29,2017.The patient developed paroxysmal abdominal pain after consuming greasy foods,accompanied by nausea.The physical examination revealed the following:temperature 37.0°C,pulse 76 bpm,respiratory rate 19 per minute,blood pressure 164/77 mmHg;no jaundice;abdominal distention;and mild total abdominal tenderness,mainly located in the left upper abdomen.Murphy’s sign was positive.Urgent abdominal ultrasound showed postprandial gallbladder emptying,gallbladder stones,unclear gallbladder cavity,and focal hepatic lesions.Hemangioma was suggested.The intrahepatic bile duct was mildly dilated,and the abdominal and pelvic cavity showed no obvious accumulation of fluid.The laboratory findings were as follows:serum amylase 922.1 U/L,white blood cell count 18.2×109/L(neutrophils,83.4%),and hemoglobin 13.8 g/dL.

Short- and Long-term Outcomes in Patients with Connective Tissue Diseases Undergoing Percutaneous Coronary Intervention

Background： Coronary artery disease （CAD） is a leading cause of morbidity and mortality in patients with connective tissue diseases （CTDs）. Risk factors and clinical characteristics in these patients are not equivalent to those in traditional CAD patients. The objective of this study was to report short- and long-term clinical outcomes in a consecutive series of patients with CTD who underwent percutaneous coronary intervention （PC1） with stent implantation. Methods： The study group comprised 106 consecutive patients with CTD who underwent PCI in Beijing Friendship Hospital between January 2009 and June 2012. Medical records were analyzed retrospectively including clinical basic material, coronary angiogram data, and the incidence of major adverse cardiac events （MACEs） during the short- and long-term （median 3 years） follow-up. Results： Ninety-two of the patients （86.8%） had one or more traditional CAD risk lhctors. Multivessel disease was present in more than 2/3 of patients （73.6%）. Tbe left anterior descending coronary artery was the most commonly affected vessel （65. 1%）. Five bare-metal stents and 202 drug-eluting stents were implanted. After a median follow-up period of 36 months, thirteen patients （12.3%） died from cardiac causes, the rate of stent thrombosis was 9.4%, and the rate of target vessel revascularization （TVR） was 14.2%. Multivariate analysis revealed that hypertension （hazard ratio [HR] = 3.07, 95% confidence interval [CI]： 1.30-7.24, P = 0.041 ）, anterior myocardial infarction （HR - 2.77. 95% CI： 1.06-7.03, P = 0.04）, longer duration of steroid treatment （HR - 3.60, 95% CI： 1.43-9.08, P 0.032）, and C-reactive protein level 〉10 mg/L （HR 3.98, 95% CI： 1.19 12.56, P = 0.036） were independent predictors of MACEs. Conclusions： Patients with CTD and CAD may have severe coronary lesions. PCI in these patients tends to result in an increased rate of stent thrombosis and TVR during long-term follow-up, which may be influenced by traditional and nontraditional risk factors.