Mesenteric vascular problems are infrequent, but may be catastrophic. During a 26-year period, 55 private patients were treated for the following disorders: (1) 12 patients with visceral artery aneurysms, (2) 8 with celiac compression syndrome, (3) 13 with chronic mesenteric ischemia, (4) 12 with acute mesenteric ischemia, and (5) 10 with mesenteric ischemia associated with aortic reconstructions. Splenic artery aneurysms were managed by excision and splenectomy, while celiac and hepatic had excision with graft replacement. Patients with celiac compression syndrome underwent lysis of the celiac artery. Two patients had compression of both celiac and superior mesenteric artery (SMA). One patient required vascular reconstruction of both arteries for residual stenoses. Patients having chronic mesenteric ischemia were treated with bypass grafts, with one death (7.7% mortality) and good long-term results. Those with acute mesenteric ischemia were treated by SMA embolectomy, bowel resection, or both, with a mortality of 67%. When associated with aortic reconstructions, mesenteric ischemia carried a mortality of 100% if bowel infarction occurred after operation, but when prophylactic mesenteric revascularization was performed at the time of aortic surgery, prognosis was greatly improved, with only one death among six patients. An aggressive approach including prompt arteriography with early diagnosis and surgical therapy is advocated for these catastrophic acute mesenteric problems.
INTRODUCTION AND OBJECTIVES: Adolescents and young adults are at increased risk of sexually transmitted infections (STI's). Although it is well known that mental health can influence sexual risk, more research is needed to understand how body image in adolescence affects sexual behaviors in young adulthood. The objective of this study was to identify the association between adolescent self-perceived body image and sexual risk in young adulthood.METHODS: We used prospective cohort data of adolescents ages 11-18 who were followed through ages 18-26 from the National Longitudinal Study of Adolescent to Adult Health. The baseline sample was nationally representative with respect to region, urbanicity, size, type and ethnicity of students from 80 U.S. high schools with paired middle schools. Exposures of interest included self-perceived weight, physical fitness (11-18 years), and attractiveness (18-26 years). Sexual risk outcomes (at 18-26 years) include number of sexual partners and STI's. Multivariable linear and logistic regression was used to predict sexual risk outcomes according to body image perception, stratified by sex.RESULTS: 11,770 participants met inclusion criteria at baseline, including 5,463 boys and 6,307 girls. At ages 18-26 years, the median number of sexual partners was 4 (IQR:2-8) and 7.5% reported having ever had a sexually transmitted infection. Adolescent selfperception of being "very overweight" was associated with a greater number of sexual partners (B[1.18, p[0.021) in females but fewer sexual partners (B[-2.20, p[0.002) in males compared to selfperception of "about the right weight." Self-perception of being "not at all attractive" was associated with fewer sexual partners in both males and females (Table 1), and lower odds of STIs. Self-perceived physical fitness was associated with a greater number of partners in males but fewer partners in females.CONCLUSIONS: Although self-perceived attractiveness was associated with greater sexual risk in both males and females, weight and fitness body image affected males and females differently. Differences in body image largely had no effect on STI acquisition in both males and females. Future research should further investigate sex differences in sexual risk factors in adolescents and young adults.
Introduction: Abdominal pain is a common chief complaint that can represent a wide breadth of diagnoses, ranging from benign to life-threatening. As our diagnostic tools become more sophisticated, we are able to better identify more causes of potentially life-threatening diseases. One such disease that is relatively unfamiliar to clinicians is spontaneous isolated celiac artery dissection (SICAD). Case Report: We describe a case of a 46-year-old man who presented to our emergency department with a chief complaint of abdominal pain and was found to have a SICAD and was successfully treated with anticoagulation, antihypertensives, and observation. Conclusion: It is important for emergency physicians to keep this potentially life-threatening condition in mind and to know the appropriate first steps once identified.
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