RESUMO
The outcome in 72 patients with obscure abdominal pain and a positive Carnett's (abdominal wall tenderness) test, seen in one firm's surgical outpatient clinic between 1975 and 1983, was sought by a combination of hospital note retrieval and general practitioner questionnaire. Full follow-up data to date or death were available for 58 (81 per cent) patients and partial follow-up for 14 patients. The study showed that the patients generated a good deal of investigation and a number of surgical procedures but that seldom were their symptoms attributable to serious pathology. Familiarity with the test, taken in the context of a proper history and examination, has been found helpful in assessing such patients and saves the inconvenience, expense and occasional hazard of investigation, and even surgery.
Assuntos
Músculos Abdominais , Dor Abdominal/etiologia , Palpação , Dor Abdominal/diagnóstico , Adolescente , Adulto , Idoso , Criança , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico , Valor Preditivo dos TestesRESUMO
Effective early treatment of this serious condition is necessary to prevent death. Urgent exploration by the most experienced surgeon available should include wide excision of all necrotic or dubious tissue, and adequate drainage of deep fascial planes. Deep and apparently healthy tissues must be exposed and the surgeon must be prepared to proceed to laparotomy, and even diverting colostomy and/or suprapubic cystotomy when necessary. Cross matched blood must be available, and we have found hydrogen peroxide irrigation useful. Pus, tissues, and blood samples for bacteriological culture and sensitivity should always be sent, but broad spectrum antibiotics should be started without delay to prevent systemic complications. In addition to the urgent initial surgery, repeated daily examination of all wounds is necessary, usually under general anaesthesia to allow full inspection, further débridement, irrigation and change of dressings, until the infective process is halted. This is a serious condition with a high mortality which we believe may be reduced by early diagnosis and appropriate aggressive surgery.
Assuntos
Fasciite/cirurgia , Escroto/patologia , Idoso , Celulite (Flegmão)/patologia , Celulite (Flegmão)/cirurgia , Fasciite/patologia , Gangrena , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Cuidados Pós-Operatórios , Escroto/cirurgiaRESUMO
Six women who sustained injury to a breast from seatbelt straps during road traffic accidents are presented. In three the breast contained a carcinoma. In view of the overlap of the appearance of fat necrosis and carcinoma by clinical and radiological examination all such lesions should be biopsied to exclude carcinoma as the history of the lesion can be dangerously misleading.
