Intraoperative Transesophageal Echocardiography in Management of Acute Type I Aortic Dissection With Malperfusion: A Case Report.

Acute type I aortic dissection is a life-threatening emergency with potentially devastating complications, including end-organ malperfusion. Early detection of malperfusion with intraoperative imaging allows for efficient transition to appropriate interventions. We present a case of a 65-year-old male with acute type I aortic dissection who underwent emergent surgical repair of the aortic root and hemiarch followed by acutely worsening distal malperfusion. The use of intraoperative transesophageal echocardiography played a critical role in visualizing diversion of flow to the false lumen, prompting urgent vascular surgery consultation and life-saving thoracic endovascular aortic repair.

Urological Manifestation of Cryptic Severe Psychiatric Illness.

Penile cellulitis has rarely been reported in the literature and never secondary to self-injury with subsequent sexual activity. It presents a challenging diagnostic situation in that the patient will likely be less than forthcoming about the etiology of his symptoms despite his willingness to seek formal medical attention. We present a case of penile cellulitis secondary to dermatitis artefacta in a severely depressed new submarine sailor. Initial studies for a more serious etiology were negative and he was treated with PO antibiotics for "syphilis" by the local civilian emergency department. After responding well to antibiotics, he subsequently presented back to medical in order to offer up the etiology of his penile wounds. In this report, we review the published literature on penile cellulitis and genital dermatitis artefacta. This case shows that military providers should always have psychiatric causes in their differential and not hesitate to ask about genital abnormalities. Recognition of underlying psychiatric etiology may play a key role in helping the patient get the care he or she needs.