Caution on Overdiagnosis

PEDIATRICS ◽  
1977 ◽  
Vol 60 (2) ◽  
pp. 261-261
Author(s):  
John B. Reinhart
Keyword(s):  
Abdominal Pain ◽  
Physical Examination ◽  
Surgical Intervention ◽  
X Ray ◽  
Laboratory Procedures ◽  
Careful Physical Examination ◽  
Careful History ◽  
Rule Out

I am writing to comment on the article by Bugenstein and Phibbs, which appeared in the December 1975 issue of Pediatrics (page 1073). I do not question that such herniations do occur and may need surgical intervention on occasion. Whether they cause generalized abdominal pain or cause confusion in diagnosis to the pediatrician or surgeon who takes a careful history and does a careful physical examination is my question. There is already the tendency to make a diagnosis on a "rule out" basis, and, in my opinion, there is excessive use of gastrointestinal x-ray and other laboratory procedures.

LINGUAL AND SUBLINGUAL THYROID GLANDS IN EUTHYROID CHILDREN

PEDIATRICS ◽  
1966 ◽  
Vol 38 (4) ◽  
pp. 647-651
Author(s):  
Wellington Hung ◽  
Judson G. Randolph ◽  
Domenic Sabatini ◽  
Theodore Winship
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Gland ◽  
Physical Examination ◽  
Thyroid Hormones ◽  
Hormone Therapy ◽  
Surgical Intervention ◽  
Ectopic Thyroid ◽  
Lingual Thyroid ◽  
Thyroid Glands ◽  
Careful Physical Examination

Five clinically euthyroid children with lingual or sublingual thyroid glands were seen during a 12-month period. Certain recommendations have been formulated based upon our experience with these patients. A careful physical examination should be performed to demonstrate the presence of a normally located thyroid gland in all children presenting with midline masses in the lingual or sublingual areas. When the thyroid gland cannot be palpated with certainty in these children, a scintiscan with I-131 should be carried out to determine if the mass is an ectopic thyroid gland and if a normally located thyroid gland is present. All children with lingual on sublingual thyroid glands should have a trial of full replacement thyroid hormone therapy before excision is contemplated. Thyroid therapy will prevent further hypertrophy and hyperplasia. Surgical intervention should be reserved for those children in whom there is dysphagia, dysphonia, ulceration, or hemorrhage due to a lingual thyroid gland or if the ectopic thyroid gland fails to decrease in size following a course of treatment with thyroid hormones.

scholarly journals Unusual Case of a Missing Vibrator Device in the Pelvis

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Greg J. Marchand ◽  
Katelyn M. Sainz ◽  
Ali Azadi ◽  
Alexa King ◽  
Sienna Anderson ◽  
...  
Keyword(s):  
Emergency Room ◽  
Unusual Case ◽  
Surgical Intervention ◽  
Abdominal Cavity ◽  
Traumatic Injury ◽  
The United States ◽  
X Ray ◽  
Sexual Stimulation ◽  
Emergency Room Setting ◽  
Careful History

Emergency room admissions and surgery secondary to the malfunctioning of devices intended for sexual stimulation are extremely common. Emergency room staff in the United States are commonly skilled in the detection and removal of some of these frequent occurrences. Occasionally, surgical intervention can be warranted if the device enters a cavity that cannot safely be explored in the emergency room setting. We report a case of a vibrator which was lost during sexual activity and appeared on flat plate X-ray to be in the abdominal cavity. A careful history showed that the device was of an unusually narrow diameter, and surgical intervention showed the device ultimately ended up in the bladder without traumatic injury. Following laparoscopic confirmation of the device’s location in the bladder, cystoscopic removal was performed and the patient recovered uneventfully.

scholarly journals Perforated Duodenal Diverticulum with Subtle Pneumoretroperitoneum on Abdominal X-Ray

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Yuzeng Shen ◽  
Mark Kwok Fai Leong
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Male Patient ◽  
Surgical Intervention ◽  
Duodenal Diverticulum ◽  
Differential Diagnoses ◽  
X Rays ◽  
Elderly Male ◽  
Hollow Viscus ◽  
X Ray

Abdominal pain is one of the most common presenting complaints at the Emergency Department (ED). Given the myriad of possible differential diagnoses for abdominal pain, it becomes more important to diagnose conditions requiring emergent surgical intervention early. We present a case of an elderly male patient with abdominal pain secondary to perforated hollow viscus, subtle evidence of pneumoretroperitoneum on the initial supine abdominal X-ray, and review the signs of pneumoperitoneum and pneumoretroperitoneum on plain abdominal X-rays.

scholarly journals Enlargement of salivary glands in bulimia

1994 ◽  
Vol 108 (6) ◽  
pp. 516-518 ◽  
Author(s):  
Josef Vavrina ◽  
Werner Müller ◽  
Jan-Olaf Gebbers
Keyword(s):  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Physical Examination ◽  
Medical History ◽  
Diagnostic Tool ◽  
Unusual Case ◽  
Surgical Intervention ◽  
Important Diagnostic Tool ◽  
Parotid Swelling ◽  
Rule Out

AbstractWe report an unusual case of bulimia nervosa with bilateral swelling of parotid and submandibular glands as the only symptom of the underlying behavioural disorder. Histologically, sialadenosis was diagnosed in a parotid biopsy. The parotomegaly in bulimia may be a diagnostic primer as these patients often deny their eating disorder. B-scan ultrasonography is an important diagnostic tool to assess the nature of the parotid enlargement. Hyperamylasaemia occurs commonly in bulimic patients and may help to confirm the diagnosis. All patients with suspected bulimia should have a thorough medical history and physical examination to rule out other aetiologies of asymptomatic parotid swelling. As the enlargement is usually transient surgical intervention is only rarely required.

Streptococcal Pharyngitis and Appendicitis in Children

2017 ◽  
Vol 57 (1) ◽  
pp. 36-39
Author(s):  
Jason W. Nielsen ◽  
Stuart A. Abel ◽  
Brian Kenney
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Ultrasound Imaging ◽  
Surgical Intervention ◽  
Streptococcal Pharyngitis ◽  
Negative Appendectomy ◽  
Younger Patients ◽  
Negative Appendectomy Rate ◽  
Rule Out

Background. Several pathologies, including pharyngitis, are associated with abdominal pain that can mimic appendicitis. We sought to further understand the link between appendicitis-like symptoms and streptococcal (strep) pharyngitis. Methods. All patients undergoing ultrasound imaging for appendicitis in our emergency department during 2013 were reviewed (n = 1572). A total of 207 patients were identified who underwent both ultrasound for appendicitis and testing for strep pharyngitis. Demographic and outcomes data between rule out appendicitis patients who underwent strep testing and those who did not were compared. Results. Strep testing was more common in younger patients (mean age = 8.26 vs 10.26 years P < .001) and evenly matched by gender (104 male, 103 female). Of the 207 patients tested for strep pharyngitis, 8 (3.9%) patients had appendicitis and 35 (16.9%) patients tested positive for strep pharyngitis. No cases of concurrent strep pharyngitis and appendicitis were identified. The negative appendectomy rate in the strep pharyngitis tested group was 38.5% (5/13), compared with 7.7% (23/296) ( P = .003) in the nontested group. The appendicitis rate among the strep tested group was 3.8% (8/207) compared with 20% (273/1365) in the nontested group ( P < .001). Conclusions. Patients undergoing testing for strep pharyngitis were younger, had lower rates of appendicitis, and had a higher rate of negative appendectomy. A diagnosis of concurrent appendicitis and strep pharyngitis is rare. In cases of patients with sufficient symptoms to warrant testing for strep pharyngitis a diagnosis of appendicitis is less likely and surgical intervention leads to higher negative appendectomy rates.

scholarly journals Stings of the missing string: missing Copper T thread

2019 ◽  
Vol 9 (1) ◽  
pp. 99
Author(s):  
Ketaki K. Junnare ◽  
Saloni Sawaskar ◽  
G. S. Shekhawat
Keyword(s):  
Abdominal Pain ◽  
Retrospective Study ◽  
Vaginal Bleeding ◽  
Patient Record ◽  
Transvaginal Ultrasonography ◽  
X Ray ◽  
Rule Out ◽  
Artery Forceps

Background: Missing CuT thread is a worrisome complaint for a woman. The string may be curled in or the Cu T might have expelled or migrated.Methods: It was a retrospective study. Authors collected the data between January 2017 to December 2017. Data was collected from OPD, OT register and Indoor patient record file. The objective was to ascertain the symptomatology, type of insertion, investigations and mode of retrieval of CuT.Results: There were 63 cases of missing CuT thread, out of which, 42 were postpartum. 33 patients were asymptomatic. Irregular vaginal bleeding (19 patients) was commonest complaint, followed by abdominal pain (10 patients). Pregnancy was detected in one patient. Transvaginal ultrasonography (TVS) detected intrauterine location of CuT in 60 cases. X-ray abdomen erect was needed in 3 cases, which detected intra-abdominal migration of CuT in two cases. CuT was expelled in third case. In 31 patients, CuT was removed by artery forceps in OPD. In 17 cases, hysteroscopic Copper T removal was needed. Two cases with migrated CuT underwent laparoscopy for retrieval of CuT. One patient had to be converted to laparotomy to rule out bowel injury.Conclusions: Missing CuT thread is commonest with postpartum IUCD. TVS should be first investigation in missing CuT thread. X-ray abdomen is needed only if CuT is not visualized on TVS. Hysteroscopy can be used in patients where CuT retrieval with artery forceps fails. Laparoscopy and laparotomy may be required in migrated CuT cases.

TUMORS OF THE BREAST IN ADOLESCENT FEMALES

PEDIATRICS ◽  
1968 ◽  
Vol 41 (4) ◽  
pp. 743-749
Author(s):  
W. A. Daniel ◽  
Michelle D. Mathews
Keyword(s):  
Physical Examination ◽  
Adolescent Girl ◽  
Psychological Trauma ◽  
Adolescent Females ◽  
Medical Advice ◽  
Age Group ◽  
Complete Physical Examination ◽  
Laboratory Procedures ◽  
Early Discussion ◽  
Careful Physical Examination

Ninety-five patients, 12 to 21 years of age, had tumors of the breast removed during a 10-year period. Fibroadenomas were found in 94% and none of the tumors were malignant. Symptoms were rarely of a degree to cause the patient to seek medical advice, and the tumors were usually found by the physician during the course of a complete physical examination. Laboratory procedures have not been effective in differentiating the types of tumors preoperatively in the adolescent age group. Careful physical examination remains the greatest diagnostic tool. Many girls who discover the tumor themselves erroneously assume it is malignant and may postpone medical examination due to fear or because they dread an assumed postoperative appearance. We advocate early discussion of the problem with the adolescent girl and teach her to examine her own breasts once a month. Hopefully, our program will prevent psychological trauma should she develop a mammary tumor.

Pancytopenia: A Challenging Problem for Treating Physician

2018 ◽  
Vol 2 (01) ◽  
pp. 22-28
Author(s):  
Md. Rezaul Karim Chowdhury ◽  
Amina Begum ◽  
Md. Haroon Ur Rashid ◽  
Md. Kamrul Hasan
Keyword(s):  
Bone Marrow ◽  
Physical Examination ◽  
Blood Smear ◽  
Peripheral Blood Smear ◽  
Bone Marrow Examination ◽  
Challenging Problem ◽  
Trephine Biopsy ◽  
Life Threatening ◽  
Underlying Pathology ◽  
Careful History

Pancytopenia is an important clinico-haematological entity and striking feature of many serious and life-threatening illnesses. Many haematological and non-haematological diseases involve the bone marrow primarily or secondarily and cause pancytopenia. Decrease in haemopoietic cell production, ineffective haemopoiesis and peripheral sequestration or destruction of the cells are the main pathophysiology of pancytopenia. The cause of pancytopenia thus may be lying in the bone marrow or in the periphery or both. Careful history, physical examination, simple blood work, review of the peripheral blood smear, sometimes bone marrow examination and trephine biopsy are required for diagnosis. Treatment and prognosis depend on the severity of pancytopenia and underlying pathology.

Small Bowel Obstruction

2010 ◽  
Vol 21 (2) ◽  
pp. 187-194
Author(s):  
Colleen Trevino
Keyword(s):  
Small Bowel ◽  
Physical Examination ◽  
Surgical Intervention ◽  
Signs And Symptoms ◽  
Bowel Ischemia ◽  
Key Factors ◽  
The Past ◽  
Factors Influencing ◽  
Imaging Response

Strategies for the management of small bowel obstructions have changed significantly over the years. Nonoperative medical management has become the mainstay of treatment of many small bowel obstructions. However, the key to the management of small bowel obstructions is identifying those patients who need surgical intervention. Identification of those at risk for bowel ischemia and bowel death is an art as much as it is a science. Using the current literature and the past knowledge regarding small bowel obstructions, the clinician must carefully identify the signs and symptoms that suggest the need for operative intervention. Classification of the obstruction, history and physical examination, imaging, response to decompression and resuscitation, and resolution or progression of symptoms are the key factors influencing the management of small bowel obstructions.

scholarly journals Foreign Body in abdomen

2015 ◽  
Vol 14 (2) ◽  
pp. 210-212
Author(s):  
Md Zakirul Alam ◽  
Mohibul Aziz
Keyword(s):  
Abdominal Pain ◽  
Foreign Body ◽  
Medical Science ◽  
X Ray ◽  
Diagnostic Center ◽  
History Of ◽  
Upper Abdominal ◽  
Married Female

A 19 years old married female presented with severe upper abdominal pain, repeated vomiting having history of swallowing a knife 7 months ago was admitted in Mordern Clinic and Diagnostic center, Joypurhat, Bangladesh. USG abdomen & X-ray (fig-1) abdomen were done when presence of a large foreign body (knife fig-3) in abdomen was made which latter on confirmed by Endoscopy of upper GIT (fig-2). Surprisingly the patient kept it in her abdomen for 7 months without any symptoms until the symptoms got worse and compelled her to seek medical help. The knife was removed by laparotomy, gastrotomy with uneventful recovery.Bangladesh Journal of Medical Science Vol.14(2) 2015 p.210-212

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