A Case of Late Diagnosis of Acute Aortic Dissection Involving the Carotid Arteries in a Patient Presenting with Signs of Acute Ischemic Stroke.

BACKGROUND Acute aortic dissection (AAD) is a rare but life-threatening condition with high mortality. The Stanford classification of aortic dissection includes type A, which originates in the ascending aorta, and type B, which originates in the descending aorta. The diagnosis may be missed due to its ability to mimic other more common cardiovascular conditions. A case is presented of late diagnosis of AAD involving the right carotid arteries in a 55-year-old man who presented with acute ischemic stroke. CASE REPORT A 55-year-old man presented with sudden onset of left-sided facial weakness and aphasia. He was diagnosed with acute ischemic stroke and treated with tissue plasminogen activator. Further imaging showed an AAD involving the entire length of the aorta. Treatment with tissue plasminogen activator was discontinued, and the patient underwent surgical repair of the aorta. His hospital stay was complicated by acute kidney injury (AKI), pneumonia, and sepsis, and he died three weeks later from renal failure. CONCLUSIONS This case demonstrated that AAD can be challenging to diagnose, and may present atypically with ischemic stroke when it involves the carotid arteries. In such cases, imaging studies of the chest, abdomen, and head and neck may identify AAD and prevent inappropriate treatment with anticoagulants.

Rectal foreign body of a shattered glass bottle; Case report of unexpected late post-operative hemorrhage managed transanally.

INTRODUCTION: Retained rectal foreign bodies are commonly implicated in patients engaging in erotic behavior. The foreign bodies vary widely, however, penetrating rectal wounds are uncommon and often complicate the retrieval of the object. The rich vascular bed of the rectal mucosa provides additional bleeding complications. PRESENTATION OF CASE: A 55-year-old male presented with active bleeding after intentional insertion of a glass bottle into the rectum which shattered. Partial retrieval via proctoscopy was followed by an exploratory laparotomy with a diverting colostomy, mucous fistula, and presacral drainage. Postoperative course was complicated by severe hematochezia. Colonoscopy was performed in the operating room found actively bleeding ulcers at sites of previously lacerated mucosa; one pulsating, protruding, vessel was visible. Clips were placed over the vessel with cessation of bleeding. Barium enema at three months follow revealed no leaks allowing for reversal of the colostomy. DISCUSSION: This case of operative retrieval of a rectal foreign body is unique because it displays deviation from commonly used algorithms are periodically needed to optimize patient recover. CONCLUSION: The utilization of minimally-invasive colonoscopy prior to additional surgical intervention in post-operative rectal bleeding following a rectal foreign body retrieval may improvie patient recovery time, functionality, and long-term outcomes.

Infliximab-induced Depression and Suicidal Behavior in Adolescent with Crohn's Disease: Case Report and Review of Literature.

Infliximab, an anti-inflammatory agent, is used to treat various autoimmune disorders. There are at least 3 reports of severe psychiatric adverse effects of the drug, including suicidal behaviors in adults and psychosis in adult and adolescent patients. We report a case of an adolescent who developed depression and suicidal behaviors shortly after beginning infliximab. Although there have been reports of adolescents developing acute psychosis shortly after starting infliximab, this is, to our knowledge, the first report of adolescent suicidal behavior in the setting of infliximab treatment. METHODS: We describe a patient's presentation and clinical course, as well as existing reports of adverse psychiatric effects of infliximab. RESULTS: A 16-year-old male with a 2-year history of disabling symptoms and complications of Crohn's disease was initiated on a trial of infliximab. Within days of the first infliximab infusion, he experienced symptoms of depression, which intensified over weeks and resulted in a serious suicide attempt. The patient was treated with fluoxetine, melatonin, and psychotherapy, which effectively managed his infliximab-induced depressive disorder with suicidal thoughts and behaviors. Posttreatment, he tolerated additional infliximab infusions without the recurrence of psychiatric symptoms. CONCLUSIONS: Treatment with infliximab may rarely and suddenly cause severe and potentially life-threatening psychiatric symptoms. Therefore, youth with chronic illnesses considered for infliximab treatment should be screened for preexisting, as well as for a family history of, psychiatric disorders and suicidal behavior.

Female Genital Mutilation: Health Consequences and Complications-A Short Literature Review.

Female genital mutilation (FGM) is a procedure performed on women in developing countries and is underreported; it involves cutting or altering the female genitalia. The health consequences of FGM include bacterial and viral infections, obstetrical complications, and psychological problems. In this study, we report FGM societal importance, ramifications, classifications, cultural significance, prevalence, complications, implications, and treatment. Although efforts have been made to eradicate FGM, the dynamics that perpetuate the practice have societal roots. Intervention methods to promote change from within the community are necessary for successful eradication of the practice. For prevention, further studies are needed to develop programs that raise awareness.