Patient: Female, 68Final Diagnosis: Adrenal hemorrhageSymptoms: Abdominal and/or epigastric painMedication: RivaroxavanClinical Procedure: —Specialty: General and Internal MedicineObjective:Rare diseaseBackground:Adrenal hemorrhage is an uncommon and under-recognized disorder with a wide array of etiologies ranging from pregnancy to septic shock. It is one of the complications of anticoagulation therapy, including direct anticoagulant medications.Case Report:Here, we present a case of a 68-year-old female with recent right knee arthroplasty who was on rivaroxaban for deep vein thrombosis (DVT) prophylaxis presented to the emergency department (ED) for severe acute onset abdominal pain, computed tomography (CT) of abdomen and pelvis revealed possible left adrenal hemorrhage that was confirmed with magnetic resonance imaging (MRI). On repeat CT, her unilateral adrenal hemorrhage converted to a bilateral adrenal hemorrhage (BAH) and, as a result, the patient developed adrenal insufficiency.Conclusions:An undiagnosed and untreated adrenal hemorrhage can have catastrophic consequences, leading to adrenal insufficiency with potential shock and death. Therefore, it is important for clinicians to have an increased awareness and knowledge about adrenal hemorrhage.

6-Vinylfulvenes constitute a class of fulvenes that are difficult to access due to the lack of a general method for their synthesis. In particular, the unsubstituted parent system has been very difficult to obtain by existing methods.In this communication we describe a convenient 3-step protocol for the synthesis of the title compound by way of sulfide oxidation and subsequent sulfoxide elimination.

Renal dysfunction after transplant is rare and associated iliac artery stenosis leading to refractory heart failure is extremely rare. Renal artery stenosis in a solitary kidney is known to lead to severe hypertension and acute pulmonary edema. Revascularization with percutaneous transluminal angioplasty of the solitary renal artery stenosis, or its equivalent, can resolve this syndrome and normalize blood pressure and volume status, though the event of hypertension is thought to occur within 15 days of transplant. We describe a case here of iliac artery stenosis with refractory acute heart failure, severe hypertension and threatened renal allograft transplant occurring 3 years after the transplant. Subsequent diagnosis and revascularization were curative.